Christmas Eve is but a day away. You’ve just spent the weekend baking dozens of Christmas cookies. Your shopping is complete. The standing rib roast is on the refrigerator shelf. You’ve just pulled your last pecan pie from the oven, and you’ve just sat down to relax with a cup of coffee and a piece of fruit cake to read The Durango Herald.
Let’s see what good Dr. Clark has to enlighten us about today: “Lowering your cholesterol to prevent heart attack and stroke.”
Don’t blame the timing on me. The good folks at the American Heart Association and American College of Cardiology have chosen the holiday season (last month to be exact) to release the first update to the national cholesterol management guidelines in five years.
Despite some minor controversy about how to best calculate heart disease risk for some groups of Americans, the new guidelines are robust, fairly simple and offer hope to help millions of Americans live longer and healthier lives.
The guidelines basically stress three things:
First, lifestyle modification is the foundation (in the words of the expert panel) for efforts at reducing the risk of atherosclerotic coronary vascular disease.
Second, decisions about whether medication therapy to lower cholesterol in a particular person is appropriate should be based on a conversation between a patient and his or her doctor considering that person’s unique situation.
Lastly, far and away the most effective strategy for medication-based reduction of cardiovascular risk is the use of the class of medications known as statins. (Examples include Zocor and Lipitor.)
These new guidelines focus only on cholesterol-lowering strategies to reduce risk of coronary heart disease, stroke and peripheral artery disease. It is based upon dozens of clinical trials in thousands of adults that provide fairly convincing evidence about how to prevent adverse cardiovascular events (such as heart attack and stroke) both in people with known heart disease and in those with risk factors for heart disease.
Regardless of whether cholesterol-lowering drugs are right for you, the expert panel concluded that regular exercise, a heart healthy diet, maintaining a healthy weight and avoiding tobacco products are all essential to vascular health.
In certain groups, such as those with known cardiovascular disease and adults with diabetes mellitus, the expert panel found strong evidence in favor of the use of statin drugs to reduce the risk of cardiovascular events. In adults with elevated cholesterol and other heart-disease risk factors (such as smoking and high blood pressure), there was moderate to strong evidence found to support use of statin drugs to reduce cardiovascular risk.
The expert panel gave guidance to medical providers to assist patients in determining their individual risk and has encouraged a thoughtful conversation between patients and their doctors to decide what risk reduction strategy is best for them.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Health Center in Towaoc.
