There’s been a lot of debate about the new Cardiovascular Disease Prevention Guidelines targeting cholesterol management and heart disease risk, which came out recently from the American College of Cardiology and the American Heart Association. At the heart of the controversy is the less-than-perfect risk calculator they use, as well as their resulting recommendations for taking statins, such as Lipitor – or what we call atorvastatin.
The risk calculator – available at heart.org; search for “2013 prevention guidelines tool” – assesses your risk of cardiovascular disease by including factors such as age, race, gender, blood pressure, total and HDL cholesterol levels and diabetes. The way it has weighted those factors has the potential of doubling the number of Americans taking inflammation-cooling, cholesterol-lowering statins. And most surprising to many folks, that number includes more than 45 million Americans who don’t currently have cardiovascular disease.
We say, recognizing all your risk factors for cardiovascular disease – and then talking to your doctor about how to reduce each of them – is at the heart of the new guidelines. And while there’s debate about the numbers the new risk calculator generates, they alert you to a real risk that you have relative to folks who have either more or less chance of heart woes. (By the way, the RealAge calculator at realage.com is an accurate way to spot your risks and learn you what you can do to reduce them, and to make yourself younger.)
The AHA and ACC also released new guidelines to help folks manage heart-risky obesity and to adopt heart-healthy lifestyles, to be used along with the new guidelines on cholesterol management. In them, they lowered the heart-risky BMI from 30 to 25 with one co-risk (diabetes is an example). They also suggest using behavioral counseling for at least six months to help people stick with exercise and diet programs.
If you do use the new AHA/ACC risk calculator, cross-reference those results with the Reynolds Risk Score (www.reynoldsriskscore.org). It factors in family history and hs-CRP (C-reactive protein) level, which measures bodywide inflammation and the target is 1.0 or less, making it more precise for women and catching hidden risks in some men, too. You can get a test for hs-CRP the next time you have blood drawn for your cholesterol check; it’s a must-know heart health number for everyone.
Here’s where we disagree with the cholesterol management guidelines. They don’t recommend tracking changes in your cholesterol levels. We think you should. It’s helpful to know if your efforts with a healthy lifestyle – and any statin you might take – are working. So we say: Get your LDLs below 100 and your HDLs over 50, and keep track of how they go up, down or stay the same with a periodic blood test.
If it turns out you’re at risk, or you just want to stay in the clear, adopt a heart-healthy diet: every day enjoy veggies, a handful of walnuts, fruits and only 100 percent whole grains. Aim for 10,000 steps a day, do resistance exercises, manage stress, keep immunizations up to date and avoid secondhand smoke as if it were poison – it contains arsenic!
And if you’re slated for statin therapy, remember these drugs can slash heart-attack risk by 50 percent even in people with normal LDL cholesterol levels and higher-than-healthy hs-CRP scores. If you’re worried about side effects, ask your doc about taking a statin every other day and a daily dose of 200 mg CoQ10. This important enzyme seems to be depleted by statins, and taking it seems to restore exercise tolerance and muscle endurance. Also, ask your doc about taking these daily: 900 mg of omega-3 DHA; 420 mg of the purified omega-7 (containing less than 3 percent palmitic acid); 1,000 IU vitamin D-3; and 162 mg aspirin with a half glass of warm water before and after. But remember, these are not substitutes for eating only healthful food, getting physical activity and managing stress.
Dr. Mehmet Oz is host of “The Dr. Oz Show,” and Dr. Mike Roizen is chief wellness officer and chairman of the Wellness Institute at Cleveland Clinic.