Johns Hopkins, Mayo Clinic: Changes to heart disease prevention needed

By: Emily Lunardo | Health News | Thursday, August 13, 2015 - 11:30 AM

Changes to heart disease preventionExperts from Johns Hopkins and Mayo Clinic have made suggestions to improve and adjust previous guidelines set in 2013 by the American Heart Association and the American College of Cardiology.

Recommendations from the 2013 guide include changes to diet, like choosing fruits and vegetables, advice to lower blood pressure and how to embark on physical activity. Each recommendation is graded with letters A, B, C, D, E and N to determine the level of importance.

Researchers feel their new recommendations will ease and clarify any confusion or misunderstandings created by the 2013 guidelines. Lead author, Miguel Cainzos-Achirica, said, “Given that heart disease and stroke are top killers worldwide, even small improvements in the way we identify and treat those at risk could yield tremendous benefits both in reducing human suffering and health care costs.”

The 2013 guidelines are scheduled to be revised in the next coming years. Authors of the new recommendations felt it was important to get an early start on these revisions in order to better prevent heart attack and stroke. Currently, many clinicians do not favor some of the guidelines, which can be problematic because adherence to them is only useful if the clinician actually believes in them.

One controversial guideline in particular surrounds the accuracy of predicting a patient’s risk which can forecast their likelihood of experiencing a stroke or heart attack over a decade.

As the current guidelines stand, those with high cholesterol but no obvious or symptomatic heart disease should consider the use of statins if their 10 year risk of heart attack or stroke is 7.5 percent or more. Unfortunately, there are flaws in the algorithm which can overestimate one’s risk, causing major concern amongst experts.

Dependence on clinical calculators can be harmful as many of them overestimate risk, and relying on these calculators can lead to over-prescribing of statins and other unnecessary treatments. The new suggestions offer recommendations which can enhance precision of these clinical calculators. The new formula would examine risk based on historical populations as opposed to modern ones. The current calculator only determines risk from populations in the 1970s and 1980s whose risk profile is worse than modern-day populations.

Senior author, Seth Martin, said, “Electronic medical records put at our fingertips a wealth of new information, so recalibrating risk calculators periodically is not the pipe dream that it was 10 years ago.”

Furthermore, current guidelines only distinguish risk between African-Americans and Caucasians leaving out many other popular ethnic groups. The new recommendations aim to include these other groups. Martin added, “Subtle and not-so-subtle racial and ethnic differences in heart disease should be reflected in how we measure risk and tailor treatment.”

Additional recommendations suggest looking more closely at patients with borderline risk. Martin commented, “For those at low or high risk for an event, treatment choices are rather straightforward. But in those with borderline scores, that decision can become a knotty clinical dilemma.”

To combat this dilemma the revised guidelines should offer tests to clarify a patient’s risk then move toward treatment.

New guidelines should also offer alternatives to cholesterol statins. Healthy lifestyle changes should always be the first course of action, but many clinicians are unaware of the point where statins should be introduced if lifestyle changes fail. Therefore, new revisions should clarify the point where lifestyle changes fail and when medical intervention should be used. It should also be further defined as to what constitutes “successful” lifestyle changes.

Martin concluded, “Physicians from across the world come together all the time to produce astonishing new insights in science. We generate all the evidence together, so we should be able to apply it together. We hope our report provides the blueprint for doing it.”

The new suggestions can be found in Mayo Clinic Proceedings.


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