Blood Sugar Level Table Conversion

The first in a five-part series of articles that explain the new heart disease and stroke prevention guidelines.

Obesity should be treated like a disease and cholesterol-lowering drugs could prevent cardiovascular disease in more Americans than previously thought, according to new cardiovascular prevention guidelines released Tuesday by the American Heart Association and American College of Cardiology.

The updated guidelines for healthcare providers also urge overall healthy diets rather than stressing about occasional indulgences. And they give doctors the first-ever formulas to calculate heart and stroke risk specifically for African-Americans – who face disproportionate risks for these diseases.

“The key message here is that we know weight loss isn’t just about will power,” said Donna Ryan, M.D., co-chair of the committee that wrote the guideline and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge. “It’s about behaviors around food and physical activity, and getting the help you need to change those behaviors.”

More Americans could benefit from statins

Cholesterol-lowering statin drugs could be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. That’s according to a new cholesterol guideline from the American Heart Association and American College of Cardiology.

This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.

Statins are drugs that lower the amount of cholesterol circulating in the blood. Seven statin drugs are currently available in the U.S.

“We’ve been undertreating people who need statin therapy in this country,” said American Heart Association volunteer Donald Lloyd-Jones, M.D., one of 20 experts on the committee that wrote the new guideline.

Examples of groups that would exceed the 7.5 percent risk threshold and therefore benefit from statin therapy include white women over 60 who smoke and have high blood pressure and African-American men over 50 with high blood pressure.

“Statins lower cholesterol levels, but what they really target is overall cardiovascular risk,” said Lloyd-Jones, a preventive cardiologist and chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Ideally, the level of bad (LDL) cholesterol should be below 100 milligrams per deciliter of blood (mg/dL). It is considered high at 160 mg/dL. For someone taking a statin, the risk for a heart attack or stroke drops by about 20 percent for each 39 mg/dL reduction in bad (LDL) cholesterol, according to the guideline. Bad cholesterol is considered high at 160 mg/dL.

The guideline recommends statin therapy for the following groups:

• People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
• People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
• People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).

Americans can lower blood pressure even further by getting sodium down to 1,500 mg a day. Cutting out processed foods high in sodium may be necessary to stay below that threshold.

“We all eat too much sodium, and this guideline provides further evidence that we’d all do well to eat less of it,” Eckel said.