New Heart-Health Guidelines - And What I Think About Them

I'll start by a disclaimer. I'm not a doctor.

That being said, I might know as much as your doctor about heart disease, stroke and cholesterol.

In general, the rule of thumb used to be to get your total cholesterol number low, especially your LDL. Raising the HDL component was also important, but stubbornly hard to do with drugs (I had good results raising my HDL with huge doses of niacin).

But researchers found that having low cholesterol numbers didn't improve health outcomes. People who suffered heart attacks and stroke had numbers all over the place.

They published a huge study this month called the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk - A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

So What Are The "New" Guidelines

The new focus is not on your cholesterol numbers - total cholesterol, HDL, LDL, and triglycerides. In fact, all the manic numbers watching that people did - myself included - is now discarded. Although they still want you to know a couple of them.

In it's place we have three new guidelines to follow:

1. Stop watching and worrying about your cholesterol numbers - unless your LDL is very high (190mg/dl or 4.8mmol/l).
2. Know your heart disease/stroke risk. The American Heart Association has a downloadable Excel spreadsheet. Variables in the spreadsheet are listed below.
3. If you find yourself in the risk category, use medication to reduce that risk. The drug of choice here is a statin (Zocor, Crestor, etc). The number they use is 7.5% risk in the next 10 years. Or if you have heart disease. Or diabetes. Or are African American. Or breathe air. Or have a pulse. (I'm only slightly kidding about the last two).

This will probably increase - some say double - the number of people on cholesterol lowering statin drugs.

What Questions Does The Calculator Ask You?

When you download the spreadsheet, it asks you 9 questions to determine your risk (the optimal answer in brackets).

1. Sex - Male or Female
2. Age
3. Race - African American or everybody else
4. Total Cholesterol (170mg/dl or 4.3mmol/l)
5. HDL Cholesterol (50mg/dl or 1.3mmol/l)
6. Systolic Blood Pressure (110 mm Hg)
7. Treatment for High Blood Pressure - Y/N (N)
8. Diabetes - Y/N (N)
9. Smoker - Y/N (N)

After you fill it in, the calculator will give you your 10-year ASCVD (Atherosclerotic Cardiovascular Disease) risk as a percentage. Mine was 4.1%.

And What Do I Think About Them?

From what I've learned and experienced:

• I'm glad to see that the focus on cholesterol numbers is waning. They're wrong-headed.
• I think the risk calculator is ridiculous simple. A small change in one number greatly effects the risk calculation. Notice there's nothing in there about weight, diet, exercise, sleep, stress.....
• I'm disappointed (but not surprised) to see that we still think statins are the answer if you have any risk. There are side effects, which are almost never talked about. The use of statins is hugely controversial, and the evidence to believe they extend life or reduce mortality is mostly non-existant. Take a look here.
• I think lifestyle changes are the very best way to improve health outcomes, but we're too damned lazy to incorporate them. We'd rather take a pill and make the pharmaceutical companies rich.
• Lose weight, exercise, eat real food. That's it. That's the secret.

What If I'm Already Taking A Statin?

Do yourself a huge favor, and watch this ABC Network (Australia) program - too bad we can't do something like this in North America.

Then do some research, and make up your own mind.

I myself stopped taking any medication - except a daily 82mg aspirin - 18 months ago. 

I thnk I'm right. I bet my life on it.