Answers to questions about the new guidelines

The American Heart Association and the American College of Cardiology released four cardiovascular prevention guidelines Tuesday, providing evidence-based guidance to help healthcare providers provide the best care to their patients in the areas of cholesterol, obesity, lifestyle and risk-assessment.

Over the coming months heart.org will offer several new tools to help healthcare providers and patients alike better understand how to incorporate these recommendations to help prevent heart disease, stroke and other cardiovascular issues.

In the meantime, here are answers to some of the basic questions you may be wondering about:

I know that my overall health isn’t great.  Do the new guidelines say I should start statins right away? What else should I do?

There are two things you should do: First, talk to your doctor. Second, assess what kind of lifestyle changes you should try to adopt. Stopping smoking, eating healthier foods and getting enough exercise are things you always can and should be doing to improve your health. The American Heart Association’s My Life Check tool can help.

The new cholesterol guidelines say more people should be taking drugs called statins to avoid heart disease and stroke. How do I know if I need to start taking these?

Check with your healthcare professional. They’ll do an overall evaluation of all factors that might put you at risk: whether you smoke, your body weight, your blood pressure, physical activity levels, diet, blood sugar and cholesterol will all be considered to decide whether you need to add statins to the healthy lifestyle we should all be following.  If that risk assessment suggests that statins would provide a benefit for you, your provider will discuss the potential benefits and risks with you.  The assessment might suggest that you don’t need medications now, but a healthy lifestyle remains important. 

I already take statins. Do the new guidelines change my dosage?

This is a great question for your healthcare provider. The answer more than likely depends on the many factors relating to your overall cardiovascular health. One of the themes of these guidelines is that your doctor will now be looking at the big picture.  Generally speaking, statins are most helpful for people who already have heart disease, people with LDL cholesterol levels of 190 or higher, and people between the ages of 40 and 75 with Type 2 diabetes or other risks.  The new guidelines will help determine the dose of statin that would be most appropriate for your level of risk, but your healthcare provider will use their overall knowledge of you to decide that.  There will be less focus on the exact level of LDL you achieve with your lifestyle and medication, but some monitoring will still be done to be sure your medication is working. 

The new obesity guidelines talk about treating obesity like a disease. How do I know if I’m obese and need a doctor’s help?

The simplest way to check right away is to use the American Heart Association’s online calculator to check your body mass index, or BMI. When you see your healthcare provider, he or she will now start assessing whether you need treatment based on your BMI. If your BMI is over 30, you are considered obese and in need of treatment. 

How will my doctor treat my obesity?

The new guidelines encourage doctors to counsel you and to get really involved in your care. The guidelines also provide tools your doctor needs to become very involved in your case and work in close partnership with you. The guidelines recognize that there is no set weight-loss program that works for everyone, and that each person needs an individual plan. Your doctor may put you on a medically supervised weight-loss plan or advise bariatric surgery.

What about insurance? What aspects of obesity treatment will be covered?

Private plans vary widely on what they cover, so it’s best to check with your insurance provider. However, under the Affordable Care Act, Medicare and most private insurance plans already cover obesity screening and counseling for adults with a BMI of 30 or higher, and diet counseling for any adult with high cholesterol or other risk factor for cardiovascular disease. Starting in 2014, all new plans sold through the health insurance marketplace must also provide free coverage for these and other preventive services.

Do the lifestyle guidelines suggest any major changes?

There are no major changes to the advice the American Heart Association has always given. Essentially, we continue to urge people to keep following what we call “Life’s Simple 7,” which are factors and behaviors that can lower your risk: Don’t smoke, get plenty of exercise, eat a healthy diet, maintain a healthy body weight, and control your blood pressure, cholesterol and blood sugar.

Do the new guidelines suggest any major diet changes I should consider?

No. You should keep shooting for the same eating patterns we’ve always recommended, one that includes plenty of fruits, vegetables, whole grains,  fish and other lean protein, but not a lot of excess sodium, fats or added sugar. The American Heart Association’s Nutrition Center offers more guidance. 

What about sodium? Should I be avoiding salt?

You need sodium in your body and in your diet, but the average American takes in more than 3,400 milligrams each day – an amount that is far too high and can increase your risk of high blood pressure, stroke and other major problems. Unless your doctor tells you that you need more salt, the guidelines continue to urge you to reduce how much you consume. The new guidelines still advise 1,500 milligrams a day as the level with the greatest effect on blood pressure. But it also says people with high blood pressure can target a “step-down” amount of 2,400 milligrams on the way to 1,500. 

What does the risk assessment guideline mean to me?

This is a guideline that’s really intended as a guide for your healthcare providers. The upshot is, your healthcare provider now has new tools to better evaluate your overall risk. And a real improvement is having better data for African-Americans.  Again, a primary theme of these guidelines is looking at the big picture of your cardiovascular health. And your provider will help you do that.