The Diet-Heart Myth: Statins Don’t Save Lives in People Without Heart Disease

Acquired heart disease

Cardiovascular disease
Staphylococcus or staph is a group of bacteria that can cause a multitude of diseases. Not smoking or getting help quitting. I am pissed at my cardiologist. Department of Veterans Affairs and U. The small coronary arteries anastomose interconnect and are not, as previously thought, end arteries.

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These recommendations are based on a thorough and careful review of the very latest, highest quality clinical trial research. They help care providers deliver the best care possible.

This page provides some of the highlights from the new practice guidelines. The ultimate goal of the new cholesterol practice guidelines is to reduce a person's risk of heart attack, stroke and death. For this reason, the focus is not just on measuring and treating cholesterol, but identifying whether someone already has or is at risk for atherosclerotic cardiovascular disease ASCVD and could benefit from treatment.

ASCVD develops because of a build-up of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries. These practice guidelines outline the most effective treatments that lower blood cholesterol in those individuals most likely to benefit. Most importantly, they were selected as the best strategies to lower cholesterol to help reduce future heart attack or stroke risk.

Share this information with your health care provider so that you can ask questions and work together to decide what is right for you. Health care providers should focus on identifying those people who are most likely to have a heart attack or stroke and make sure they are given effective treatment to reduce their risk.

Cholesterol should be considered along with other factors known to make a heart attack or stroke more likely. Knowing your risk of heart attack and stroke can help you and your health care provider decide whether you may need to take a medication—most likely a statin—to lower that risk. If a medication is needed, statins are recommended as the first choice to lower heart attack and stroke risk among certain higher-risk patients based on an overwhelming amount of evidence.

For those unable to take a statin, there are other cholesterol-lowering drugs; however, there is less research to support their use. Your health care provider will first want to assess your risk of ASCVD assuming you don't already have it. This information will help determine if you are at high enough risk of a heart attack or stroke to need treatment.

To do this, your care provider will 1 review your medical history and 2 gauge your overall risk for heart attack or stroke. A lipid or blood cholesterol panel will be needed as part of this evaluation. This blood test measures the amount of fatty substances called lipids in your blood. You may have to fast not eat for a period of time before having your blood drawn. The results of these tests can help you and your health care team decide what might be the best treatment for you.

These tests may include:. Lifetime risk estimates —how likely you are to have a heart attack and stroke during your lifetime. Coronary artery calcium CAC score —a test that shows the presence of plaque or fatty build-up in the heart artery walls. High-sensitivity C-Reactive Protein CRP —a blood test that measures the amount of CRP, a marker of inflammation or irritation in the body; higher levels have been associated with heart attack and stroke.

Ankle-brachial index ABI —the ratio of the blood pressure in the ankle compared to blood pressure in the arm, which can predict peripheral artery disease PAD.

If you have very high levels of low-density lipoprotein LDL or "bad" cholesterol, your care provider may want to find out if you have a genetic or familial form of hypercholesterolemia. This condition can be passed on in families. Before coming up with a specific treatment plan, your care provider will talk with you about options for lowering your blood cholesterol and reducing your personal risk of atherosclerotic disease.

This will likely include a discussion about heart-healthy living and whether you might benefit from a cholesterol-lowering medication. Adopting a heart-healthy lifestyle continues to be the first and best way to lower your risk of problems. Doing so can also help control or prevent other risk factors for example: Eating a diet rich in vegetables, fruits, and whole grains ; this also includes low-fat dairy products, poultry, fish, legumes, and nuts; it limits intake of sweets, sugar-sweetened beverages and red meats.

Getting regular exercise ; check with your health care provider about how often and how much is right for you. Staying on top of your health , risk factors and medical appointments. For some people, lifestyle changes alone may not be enough to prevent a heart attack or stroke. In these cases, taking a statin at the right dose will most likely be necessary.

There is a large body of evidence that shows the use of a statin provides the greatest benefit and fewest safety issues. In particular, specific groups of patients appear to benefit most from taking moderate or high-intensity statin therapy.

Based on this information, your care provider will likely recommend a statin if you have:. Above a certain likelihood of having a heart attack or stroke in the next 10 years 7.

In certain cases, your care provider may still recommend a statin even if you don't fit into one of the groups above. Based on the guidelines, these may include:. People who have had a heart attack, stroke or other types of ASCVD tend to benefit the most from taking the highest amount dose of statin therapy if they tolerate it.

This may be more appropriate than taking multiple drugs to lower cholesterol. A more moderate dose of statin may be appropriate for some people with ASCVD, such as those over 75 years or those that might have problems taking the highest dose of a statin i. If you are 75 years or older and have not already had a heart attack, stroke or other types of ASCVD, your care provider will discuss whether a statin is right for you. Not all patients will be able to take the optimum dose of statin.

Have side effects from statins that prevent you from getting to the optimal dose or are not able to take a statin at all. As always, it's important to talk with your health care provider about which medication is right for you.

Although keeping LDL-cholesterol lower with an optimal dose of statin is supported strongly by clinical trials, getting to a specific goal level is not. Take steps to lower your risk factors for heart attack, stroke and other problems —Make healthy choices eating a healthy diet, getting exercise, maintaining a healthy weight and not smoking.

Drug therapy, if needed, can help control risk factors. Report side effects —Muscle aches are commonly reported and may or may not be due to the statin.

If you are having problems, your care provider needs to know to help manage any side effects and possibly switch you to a different statin. Get blood cholesterol and other tests that are recommended by your health care team. These can help assess whether statin therapy—and the dose—is working for you. What are my risk factors for heart attack and stroke?

Am I on the best prevention program to minimize this risk? For additional cardiovascular terms visit www. By using the Product, You accept and agree to be bound by all of the terms and conditions set forth in this Agreement.

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Click here to fill out our feedback survey. Clinicians and patients should weigh and incorporate the information provided by this app in the context of other considerations, including recommended lifestyle interventions, patient preferences for taking medications, potential adverse drug reactions or interactions, and which treatment intervention approach might be most successful for a particular patient. Form a risk-lowering intervention plan with your patient at an initial visit.

However, the app now includes additional capabilities to estimate and track change in risk over time, and forecast potential benefit of specific risk-lowering interventions.

The ASCVD Risk Estimator Plus has also expanded the guidance provided by including expert advice regarding blood pressure-lowering therapy, aspirin use, and smoking cessation, along with the original statin initiation recommendations.

The App was designed and vetted through collaboration with the authors of the source documents listed above, as well as other ACC clinical members. It was further refined via user testing with physicians, nurse practitioners, and pharmacists.

This version of the application has been locked because of need to ugrade the science. Please go to the store upgrade this application. Lifetime Risk Calculator only provides lifetime risk estimates for individuals 40 to 59 years of age. Forecast the potential impact of different interventions on patient risk. Follow up risk incorporates change in risk factor levels over time and requires both initial and follow up values. Use the information above to help with clinician-patient discussions on risk and risk-lowering interventions.

Because the primary use of these risk estimates is to facilitate the very important discussion regarding risk reduction through lifestyle change, the imprecision introduced is small enough to justify proceeding with lifestyle change counseling informed by these results. Systolic Blood Pressure mm Hg. Diastolic Blood Pressure mm Hg. Value must be between - Value must be between 3. Value must be between 20 - Value must be between 0. How long ago did patient quit smoking?

Do you want to refine current risk estimation using data from a previous visit? Values at Previous Visit. Age at Previous Visit. Total Cholesterol is Missing. Systolic Blood Pressure is Missing. On Hypertension Treatment at Previous Visit?

Treatment Hypertension is Missing. History of Diabetes at Previous Visit? Was a Smoker at Previous Visit or within a year before the visit? Risk Reduction by Therapy. View All Risk Reduction Scenarios. Risk is not shown for therapy s that are not recommended. Project Risk Reduction by Therapy. Actual Risk Projected Risk. You can reduce the amount of saturated fat in your diet by trimming fat off your meat or choosing lean meats with less than 10 percent fat.

You can also add less butter, margarine and shortening when cooking and serving. You can also use low-fat substitutions when possible for a heart-healthy diet. For example, top your baked potato with low-sodium salsa or low-fat yogurt rather than butter, or use sliced whole fruit or low-sugar fruit spread on your toast instead of margarine.

You may also want to check the food labels of some cookies, cakes, frostings, crackers and chips. Some of these — even those labeled "reduced fat" — may be made with oils containing trans fats. One clue that a food has some trans fat in it is the phrase "partially hydrogenated" in the ingredient list. When you do use fats, choose monounsaturated fats, such as olive oil or canola oil. Polyunsaturated fats, found in certain fish, avocados, nuts and seeds, also are good choices for a heart-healthy diet.

When used in place of saturated fat, monounsaturated and polyunsaturated fats may help lower your total blood cholesterol. But moderation is essential. All types of fat are high in calories. An easy way to add healthy fat and fiber to your diet is ground flaxseed. Flaxseeds are small brown seeds that are high in fiber and omega-3 fatty acids. Some studies have found that flaxseeds may help lower cholesterol in some people, but more research is needed.

You can grind the seeds in a coffee grinder or food processor and stir a teaspoon of them into yogurt, applesauce or hot cereal. Lean meat, poultry and fish, low-fat dairy products, and eggs are some of your best sources of protein.

But be careful to choose lower fat options, such as skim milk rather than whole milk and skinless chicken breasts rather than fried chicken patties. Fish is another good alternative to high-fat meats. And certain types of fish are rich in omega-3 fatty acids, which can lower blood fats called triglycerides. You'll find the highest amounts of omega-3 fatty acids in cold-water fish, such as salmon, mackerel and herring.

Other sources are flaxseed, walnuts, soybeans and canola oil. Legumes — beans, peas and lentils — also are good sources of protein and contain less fat and no cholesterol, making them good substitutes for meat. Substituting plant protein for animal protein — for example, a soy or bean burger for a hamburger — will reduce your fat and cholesterol intake and increase your fiber intake.

Eating a lot of sodium can contribute to high blood pressure, a risk factor for cardiovascular disease. Reducing sodium is an important part of a heart-healthy diet. The American Heart Association recommends that:. Although reducing the amount of salt you add to food at the table or while cooking is a good first step, much of the salt you eat comes from canned or processed foods, such as soups, baked goods and frozen dinners.

Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat. If you like the convenience of canned soups and prepared meals, look for ones with reduced sodium. Be wary of foods that claim to be lower in sodium because they are seasoned with sea salt instead of regular table salt — sea salt has the same nutritional value as regular salt.

Another way to reduce the amount of salt you eat is to choose your condiments carefully. Many condiments are available in reduced-sodium versions, and salt substitutes can add flavor to your food with less sodium. You know what foods to feature in your heart-healthy diet and which ones to limit. Now it's time to put your plans into action. Create daily menus using the six strategies listed above.

When selecting foods for each meal and snack, emphasize vegetables, fruits and whole grains. Choose lean protein sources and healthy fats, and limit salty foods. Watch your portion sizes and add variety to your menu choices. For example, if you have grilled salmon one evening, try a black-bean burger the next night. This helps ensure that you'll get all of the nutrients your body needs.

Variety also makes your meals and snacks more interesting. Allow yourself an indulgence every now and then. A candy bar or handful of potato chips won't derail your heart-healthy diet. But don't let it turn into an excuse for giving up on your healthy-eating plan.

If overindulgence is the exception, rather than the rule, you'll balance things out over the long term. What's important is that you eat healthy foods most of the time. Incorporate these eight tips into your life, and you'll find that heart-healthy eating is both doable and enjoyable. With planning and a few simple substitutions, you can eat with your heart in mind.

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By Mayo Clinic Staff. References Lichtenstein AH, et al. Diet and lifestyle recommendations revision How to avoid portion size pitfalls to help manage your weight. Centers for Disease Control and Prevention.

Dietary Guidelines for Americans, Department of Health and Human Services. How to use fruits and vegetables to help manage your weight. Flaxseed and flax oil. National Center for Complementary and Alternative Medicine. Natural Medicines Comprehensive Database. Sea salt vs table salt. Zeratsky KA expert opinion. Mayo Clinic, Rochester, Minn.

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