Major New Guidelines on Reducing Cardiovascular Risk Released — Physician’s First Watch

Medical News |
November 13, 2013

Major New Guidelines on Reducing Cardiovascular Risk Released

By Joe Elia

Guidelines encompassing four major areas aimed at reducing the risk for cardiovascular disease have been released.

The guidelines, appearing in Circulation, are likely to change clinical practice. They are the result of collaborations among the American Heart Association, the American College of Cardiology, and other organizations.

Some major recommendations from the four areas follow:

  • Obesity: There's no ideal diet for weight loss. Intensive, supervised lifestyle changes for at least 6 months receive strong endorsement.

  • Lipids: There's no longer any support for treating to specific lipid targets.

  • Risk Assessment: The guidelines offer a new calculator for measuring 10-year risk (we provide a link below).

  • Lifestyle: The guidelines emphasize heart-healthy diets and advocate restrictions to the intake of saturated fats, trans fats, and sodium.

The NEJM Journal Watch editors are reviewing the individual recommendations, and Clinical Conversations interviewed cardiologist Harlan Krumholz to get his perspective.

Reader Comments (6)

swaminathan ramkumar Physician, Internal Medicine

thanx to the guideline I am now more thoroughly confused than ever about statin use

TC RAGHURAM MD PhD Other, Other, india

Journal Watch provides valuable information on wide range of medical topics which are useful.

Ben Reiter MD Physician, Family Medicine/General Practice, Florida

The risk calculator, as downloaded, shows that any male over the age of 63, regardless of other risk factors, will have a 7.5% or greater 10 year risk. The guidelines therefore advise treating EVERY male over 63 (and every female 71 and older). I find this difficult to follow in my practice.

David Foster, MD Physician, Family Medicine/General Practice

The cardiovascular and cerebrovascular guidelines are appreciated, but overdue. Given the lack of benefit of fibrates, omega-3 supplements, niacin, and folate (despite their lipid level effects), it seems clear that the endothelial benefits of statins are the major benefit. We still need to consider other statin benefits suggested in other (esp. non-USA) studies: reductions in dementia, malignancies, and infections). The benefits can only be expected to broaden.

David Wilson, M.D. Physician

according to these new guidelines, a 62 year-old black male with no other risk factors (non-smoker, non-diabetic, non-hypertensive, with SBP 120, TChol 170, and HDL 50) should be prescribed a statin. This despite no evidence that statins reduce mortality (or morbidity) in primary prevention in anyone.

ROBERT HAILE Physician, Hospital Medicine, Maine Medical Center

I question the legitimacy of the guideline choices and wonder if they are in the best interests of patients. I realize the development of atherosclerotic plaques are multifactorial, but giving up on strict management of lipid goals seems premature.

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