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Maret 14, 2014

diam2suka: H1NDUSTAN times mengabarkaN … 14032014

Filed under: GLOBAL ECONOMY — bumi2009fans @ 1:33 pm

Malaysia plane ‘deliberately diverted’ towards Andaman: Military radar
Reuters
Kuala Lumpur, March 14, 2014

First Published: 14:20 IST(14/3/2014)
Last Updated: 18:04 IST(14/3/2014)

This handout photo taken shows a Royal Malaysian Navy Fennec helicopter preparing to depart to aid in the search and rescue efforts for the missing Malaysia Airlines plane over the Straits of Malacca. (AFP Photo)
Military radar-tracking evidence suggests a Malaysia Airlines jetliner missing for nearly a week was deliberately flown across the Malay peninsula towards the Andaman Islands, sources familiar with the investigation told Reuters on Friday.

Two sources said an unidentified aircraft that investigators believe was Flight MH370 was following a route between navigational waypoints – indicating it was being flown by someone with aviation training – when it was last plotted on military radar off the country’s northwest coast.

Read: Malaysia jet MH370 search enters Day 7; focus shifts to Indian Ocean

The last plot on the military radar’s tracking suggested the plane was flying toward India’s Andaman Islands, a chain of isles between the Andaman Sea and the Bay of Bengal, they said.

Waypoints are geographic locations, worked out by calculating longitude and latitude, that help pilots navigate along established air corridors.

A third source familiar with the investigation said inquiries were focusing increasingly on the theory that someone who knew how to fly a plane deliberately diverted the flight, with 239 people on board, hundreds of miles off its intended course from Kuala Lumpur to Beijing.

Read: Missing plane sent signals to satellite for hours | Mystery of missing jet recalls past disappearances

“What we can say is we are looking at sabotage, with hijack still on the cards,” said that source, a senior Malaysian police official.

All three sources declined to be identified because they were not authorised to speak to the media and due to the sensitivity of the investigation.

Read: Malaysia widens search for missing jet MH 370 towards India

Officials at Malaysia’s Ministry of Transport, the official point of contact for information on the investigation, did not return calls seeking comment.

Malaysian police have previously said they were investigating whether any passengers or crew had personal or psychological problems that might shed light on the mystery, along with the possibility of a hijacking, sabotage or mechanical failure.

The comments by the three sources are the first clear indication that foul play is the main focus of official suspicions in the Boeing 777’s disappearance.
As a result of the new evidence, the sources said, multinational search efforts were being stepped up in the Andaman Sea and also the Indian Ocean.

Timeline: the hunt for flight MH370

A P3C patrol plane of the Japan Maritime Self-Defense Force sits on the taxi way at Sepang air force base, Malaysia. (AP photo)
Last sighting
In one of the most baffling mysteries in modern aviation, no trace of the plane nor any sign of wreckage has been found despite a search by the navies and military aircraft of more than a dozen countries.

The last sighting of the aircraft on civilian radar screens came shortly before 1:30 a.m. Malaysian time last Saturday (1730 GMT Friday), less than an hour after it took off from Kuala Lumpur, as the plane flew northeast across the mouth of the Gulf of Thailand. That put the plane on Malaysia’s east coast.

Malaysia’s air force chief said on Wednesday an aircraft that could have been the missing plane was plotted on military radar at 2:15 a.m., 200 miles (320 km) northwest of Penang Island off Malaysia’s west coast.

This position marks the limit of Malaysia’s military radar in that part of the country, a fourth source familiar with the investigation told Reuters.
When asked about the range of military radar at a news conference on Thursday, Malaysian Transport Minister Hishammuddin Hussein said it was “a sensitive issue” that he was not going to reveal.

“Even if it doesn’t extend beyond that, we can get the cooperation of the neighbouring countries,” he said.

The fact that the aircraft – if it was MH370 – had lost contact with air traffic control and was invisible to civilian radar suggested someone aboard had turned its communication systems off, the first two sources said.

They also gave new details on the direction in which the unidentified aircraft was heading – following aviation corridors identified on maps used by pilots as N571 and P628. These routes are taken by commercial planes flying from Southeast Asia to the Middle East or Europe and can be found in public documents issued by regional aviation authorities.

In a far more detailed description of the military radar plotting than has been publicly revealed, the first two sources said the last confirmed position of MH370 was at 35,000 feet about 90 miles (144 km) off the east coast of Malaysia, heading towards Vietnam, near a navigational waypoint called

“Igari”

. The time was 1:21 am

The military track suggests it then turned sharply westwards, heading towards a waypoint called

“Vampi”

, northeast of Indonesia’s Aceh province and a navigational point used for planes following route N571 to the Middle East.

From there, the plot indicates the plane flew towards a waypoint called

“Gival”

, south of the Thai island of Phuket, and was last plotted heading northwest towards another waypoint called

“Igrex”

, on route P628 that would take it over the Andaman Islands and which carriers use to fly towards Europe.

The time was then 2:15 am That’s the same time given by the air force chief on Wednesday, who gave no information on that plane’s possible direction.
The sources said Malaysia was requesting raw radar data from neighbours Thailand, Indonesia and India, which has a naval base in the Andaman Islands.

– See more at: http://www.hindustantimes.com/world-news/malaysianairlinemystery2014/radar-data-suggests-missing-malaysia-plane-flown-deliberately-toward-andamans-sources/article1-1195029.aspx#sthash.9vwGzi2N.dpuf

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diam2suka: STAT1N – pemeriksaan lab … 141113_1403201empat

Filed under: Medicine — bumi2009fans @ 12:40 am

Statins: Side effects of anti-cholesterol drugs questioned
They’re the new anti-cholesterol wonder drugs taken by millions. But with side effects including muscle pain and depression, some experts are now asking: should they be dispensed more carefully?
Joan Hardman was secretly afraid she was going out of her mind. “I was getting more and more morose, my concentration wasn’t good and I was starting to make mistakes at work. I thought I was going senile,” says the 58-year-old bespoke blind maker from Manchester.
“Then I started getting paranoid. I was so depressed sometimes I felt suicidal.”
Both Joan and her doctor believe that what had been making her life hell was the statin drug that she had been taking for three years to lower the level of cholesterol in her blood.
Statins have been welcomed as the miracle drugs that can significantly reduce the risk of heart disease. Britons are taking more and more of them — around 2.5 million people in the UK are being prescribed statins.
The latest guidelines from NICE (National Institute for Clinical Excellence) recommend that anyone with a 20 percent risk of cardiovascular disease over the next ten years should be eligible for them. This means the number of people on statins is expected to double to more than five million within a few years.
The Department of Health estimates that statins save 9,700 lives a year. But at what cost? Experts say they are safe and well tolerated but a recent report claims that doctors and patients are not as well informed about the risks as they should be.
Earlier this month GP magazine reported that some doctors were worried that the drive to bring cholesterol levels down could be leading to stronger prescriptions which could increase the severity of side effects.
Meanwhile, in an article for the British Medical Journal, Swedish physician and cholesterol expert Dr Uffe Ravnskov claims that little is known about the side effects of taking statins at higher doses.
Dr Ravnskov and two other eminent colleagues have studied these side effects. They say there is a possibility of mental and neurological problems such as severe irritability and memory loss, and muscle weakness (myopathy) — this can make walking difficult, cause aches and pains, and in rare cases leads to total muscle cell breakdown, and kidney failure.
“I’m in touch with about 80 to 90 scientists who believe the benefits of statins have been overplayed and that the side effects are not being taken seriously enough,” he said.
These ‘sceptics’ dispute many of the claims being made for the benefits of statins, and question the interpretation of the results of large clinical trials — they argue that some which are used to justify the use of the drugs actually show no difference in survival rates between those who took statins and those who did not.
A major area of dispute is about who actually benefits from the drugs.
The sceptics argue that statins have not been shown to prevent premature death among men over 65. And “there is no controlled study that shows that cholesterol-lowering statin drugs benefit women without pre-existing heart disease“, says Dr John Abramson, author of Overdosed America, published last year.
While Ravnskov and his supporters question the value of statins,

nearly all UK experts are confident these drugs are beneficial

.
“There is almost universal benefit from statins for men over 55, regardless of their cholesterol level, and also for women over 60,” asserts Tom Sanders, Professor of Nutrition and Dietetics at King’s College, London.
Joan Hardman’s problems started after her statin dose was increased. “My partner had suffered a heart attack and he was told to take statin because he had high cholesterol; when they tested me, I was even higher!” she says.
After a year her cholesterol level had fallen from 6.7 to 4.9 but, following current advice that you should aim for below 4, her doctor doubled her dose from 10mg to 20mg. When she told her doctor about feeling depressed, having pains in her chest and back and tingling in her arm, he first said it was part of getting older. When her symptoms didn’t get any better he sent her for various tests, which proved negative.
“I then saw another doctor because mine was on holiday,” says Joan. “He told me to stop taking the statins.”
That doctor, Malcolm Kendricks, has long been sceptical about the value of aggressively lowering cholesterol.”We don’t know what effect that’s going to have because many of the recognised side effects, like muscle weakness, are the sort of symptoms that are expected among older people anyway.
Official figures show that the number of doctors’ reports of side effects and deaths linked with statins has increased significantly over the past year.
In 2005 the total number of deaths linked with these drugs over the past 18 years was 92, with 7,000 reports of adverse reactions.
The latest figures obtained from the drug watchdog, the MHRA (Medicines Healthcare products Regulatory Authority), show 38 deaths in the past year alone, with another 1,337 reports of side effects. According to some experts, the percentage of adverse drug reactions that are actually reported may be as low as 1 per cent of the total.
For Joan, the relief from being drug-free was enormous. “Two weeks after I’d come off the drugs I felt I was back to normal.”
So was Joan just unlucky, or is what happened to her a sign of a deeper problem? What Dr Ravnskov, and colleagues Morley Sutter, Emeritus Professor of pharmacology at the University of British Columbia, and Mark Houston, Clinical Professor of Medicine at the Vanderbilt University School of Medicine in Nashville, are concerned about is that, when side effects show up in clinical trials, they are not being properly described so doctors can act.
One recent trial, they said, compared the effects of giving a high dose of one brand with a lower dose of a different brand. “The results showed that almost 90 per cent of the patients in both groups had side effects, half of them serious,” says Ravnskov.
“Amazingly, the authors didn’t comment on these very high levels, nor did they tell us what the side effects were.”
The most widely recognised side-effect of statins is muscle weakness – usually considered to occur in less than 1 percent of patients.
However, Ravnskov believes this could be a serious underestimate.
The effects of statins on thinking and feeling is more controversial, but it has been researched by Dr Beatrice Golomb, Assistant Professor of Medicine at the University of California, San Diego.
“Cholesterol is vital for the development and functioning of the brain,” says Ravnskov, “so it’s not surprising that various psychological problems show up.”
The reason statins are believed to be safe, concludes Ravnskov, is that trials don’t include people who are likely to have problems.
He points to the TNT trial, published in the New England Journal of Medicine in 2005, in which 46 percent of the original pool of 18,000 people were excluded because they had some illness or didn’t respond well to the drug.
The decision whether or not to take statins is a matter of balancing benefits against possible side effects. While acknowledging the advantages of the drugs for men over 55 and women over 60, Professor Sanders is worried that ‘overzealous doctors’ prescribe them to people who are much younger than that.
But he is also worried that side effects could be more damaging than is generally realised, but not for the same reasons as Ravnskov. Speaking from the International Atherosclerosis Conference in Rome last week, he said it was “being claimed that the incidence of myopathy is low where there is careful monitoring of patients.
“However, as we know in the UK, patients are not carefully monitored. So, there is a risk that side effects are not being picked up.”
GP guidelines say they should check cholesterol levels, as well levels of enzymes that indicate if there are liver or muscle problems, before prescribing the drug, and then check again in two to three months and then yearly. In Joan’s case she collected a repeat prescription every three months.
If you do begin to feel worse after going on a course of statins, it is worth discussing with your doctor the possibility of stopping them.
For a non-drug approach, a study in the Archives of Internal Medicine last year found that omega-3 reduced the chance of dying from heart disease more than statins.

Read more: http://www.dailymail.co.uk/health/article-392689/Statins-Side-effects-anti-cholesterol-drugs-questioned.html#ixzz2vtLLezT7
==============================================================
November 12, 2013
Experts Reshape Treatment Guide for Cholesterol
By GINA KOLATA
NYT
The nation’s leading heart organizations released new guidelines on Tuesday that will fundamentally reshape the use of cholesterol-lowering statin medicines, which are now prescribed for a quarter of Americans over 40. Patients on statins will no longer need to lower their cholesterol levels to specific numerical targets monitored by regular blood tests, as has been recommended for decades. Simply taking the right dose of a statin will be sufficient, the guidelines say.

The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL — 190 or higher — should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required.

Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5 percent. Doctors are advised to use a new risk calculator that factors in blood pressure, age and total cholesterol levels, among other things.

“Now one in four Americans over 40 will be saying, ‘Should I be taking this anymore?’ ” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee.

The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take statins. In a significant departure, the new method also counts strokes as well as heart attacks in its risk calculations, a step that will probably make some additional people candidates for the drugs.

It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them.

The previous guidelines put such a strong emphasis on lowering cholesterol levels by specific amounts that patients who did not hit their target levels just by taking statins often were prescribed additional drugs like Zetia, made by Merck. But the new guidelines say doctors should no longer prescribe those extra medicines because they have never been shown to prevent heart attacks or strokes.

Zetia has been viewed with increasing skepticism in recent years since studies showed it lowered LDL cholesterol but did not reduce the risk of cardiovascular disease or death. Still, it is among Merck’s top-selling drugs, earning $2.6 billion last year. Another drug, Vytorin, which combines Zetia with a statin, brought in $1.8 billion in 2012, according to company filings. And in May, Merck won approval for another drug, Liptruzet, which also contains the active ingredient in Zetia and a statin, a development that surprised many cardiologists because of questions about its effectiveness.

The new guidelines are part of a package of recommendations to reduce the risk of heart attack and stroke that includes moderate exercise and a healthy diet. But its advice on cholesterol is the flash point, arousing the ire of critics who say the authors ignored evidence that did not come from gold-standard clinical trials and should also have counted less rigorous, but compelling, data.

For example, Dr. Daniel J. Rader, the director of the preventive cardiovascular medicine and lipid clinic at the University of Pennsylvania, points to studies of people with genes giving them low LDL levels over a lifetime. Their heart attack rate is greatly reduced, he said, suggesting the benefits of long-term cholesterol reduction.

Committee members counter his view, saying that cholesterol lowered by drugs may not have the same effect.

Critics also question the use of a 10-year risk of heart attack or stroke as the measure for determining who should be treated. Many people will have a lower risk simply because they are younger, yet could benefit from taking statins for decades to keep their cholesterol levels low, they say.

Dr. Rader and other experts also worry that without the goad of target numbers, patients and their doctors will lose motivation to control cholesterol levels.

Experts say it is still unclear how much the new guidelines will change clinical practice. Dr. Rader suspects many cardiologists will still strive for the old LDL targets, at least for patients with heart disease who are at high risk. “They are used to it and believe in it,” he said.

Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, said he thought it would take years for doctors to change their practices.

The process of developing the guidelines was rocky, taking at least twice as long as in the past. The National Heart, Lung and Blood Institute dropped out, saying that drafting guidelines was no longer part of its mission. Several committee members, including Dr. Rader, also dropped out, unhappy with the direction the committee was going.

The architects of the guidelines say their recommendations are based on the best available evidence. Large clinical trials have consistently shown that statins reduce the risk of heart attacks and strokes, but the committee concluded that there is no evidence that hitting specific cholesterol targets makes a difference. No one has ever asked in a rigorous study if a person’s risk is lower with an LDL of 70 than 90 or 100, for example.

Dr. Neil J. Stone, the chairman of the committee and a professor of preventive cardiology at Northwestern University’s Feinberg School of Medicine, said he was surprised by what the group discovered as it delved into the evidence. “We deliberated for several years,” he said, “and could not come up with solid evidence for targets.”

Dr. Nissen, who was not a member of the committee, agreed. “The science was never there” for the LDL targets, he said. Past committees “made them up out of thin air,” he added.

The Department of Veterans Affairs conducted its own independent review and came to the same conclusion. About a year ago, the department, the nation’s largest integrated health care system, dropped its LDL targets, said Dr. John Rumsfeld, the V.A.’s national director of cardiology.

“It is a shift,” he acknowledged, “but I would argue that it is not a radical change but is a course correction.”

Dr. Paul M. Ridker, the director of the center for cardiovascular disease prevention at Brigham and Women’s Hospital, in Boston, said he worried the new guidelines could easily lead to overtreatment. An older man with a low LDL level who smokes and has moderately elevated blood pressure would qualify for a statin under the new guidelines. But what he really needs is to stop smoking and get his blood pressure under control.

Dr. Stone said he hoped doctors would not reflexively prescribe a statin to such a patient. Doctors are supposed to talk to their patients and realize that, with a man like the one Dr. Ridker described, the real problem was not cholesterol.

“We are taking people out of their comfort zone,” Dr. Stone said. “Instead of being reassured that reaching this number means they will be fine, we are asking, ‘What is the best therapy to do the job?’ ”

Katie Thomas contributed reporting.
New heart disease and stroke prevention guidelines released
The first in a five-part series of articles that explain the new heart disease and stroke prevention guidelines.

Obesity should be treated like a disease and cholesterol-lowering drugs could prevent cardiovascular disease in more Americans than previously thought, according to new cardiovascular prevention guidelines released Tuesday by the American Heart Association and American College of Cardiology.

The updated guidelines for healthcare providers also urge overall healthy diets rather than stressing about occasional indulgences. And they give doctors the first-ever formulas to calculate heart and stroke risk specifically for African-Americans – who face disproportionate risks for these diseases.

These cardiovascular prevention guidelines reflect the latest views of scientific and medical experts on how to prevent heart disease and stroke, the No. 1 and 4 killers in the U.S. These guidelines are the result of experts poring over hundreds of clinical research studies and then developing recommendations about what works best, equipping doctors across the country to provide the most up-to-date care.

“These new guidelines represent the best of what scientific research can tell us about how to prevent heart disease and stroke,” said American Heart Association president Mariell Jessup, M.D., medical director of the Penn Medicine Heart and Vascular Center at the University of Pennsylvania in Philadelphia. “These recommendations will help guide the clinical decisions doctors make every day to protect their patients from two of the nation’s biggest killers.”

The guidelines are based on rigorous, comprehensive, systematic evidence reviews originally sponsored by the federal National Heart, Lung, and Blood Institute. The American Heart Association and the American College of Cardiology worked with other professional groups in finalizing these guidelines, and multiple stakeholder organizations were invited to review and endorse the final documents.

Below is a brief look at the new guidelines in obesity, cholesterol, risk assessment and lifestyle.

Obesity should be managed and treated like a disease

The best strategy to lose weight and keep it off requires a three-pronged approach: Eat fewer calories than your body needs, exercise more and change unhealthy behaviors.

Patients are more likely to stay on track when guided by a trained professional in a healthcare setting. That’s why healthcare providers are now urged to actively help patients achieve and maintain a healthier body weight, said Frank Hu, M.D., Ph.D., a professor of nutrition and epidemiology at Harvard School of Public Health in Boston.

Hu is an American Heart Association volunteer who sat on a 27-member expert committee that wrote the new Guideline for the Management of Overweight and Obesity in Adults, from the American Heart Association, American College of Cardiology and The Obesity Society.

“Clinicians should not just think of obesity as a lifestyle issue. They should treat obesity as a disease,” Hu said. “Providing preventive care services such as obesity screening and behavioral counseling are critically important.”

Included in the new guideline is a first-of-its-kind roadmap to help patients lose weight and keep it off. It starts with finding out who would benefit from weight loss by calculating at least once a year every American’s body mass index, which is an indicator of obesity based on height and weight. Patients with a BMI of 30 or higher are considered obese and need treatment. In the U.S., nearly 78 million adults are obese.

For the overweight, the new guidelines found that more people can reap rewards from weight loss than previously thought. In 1998, federal guidelines suggested that overweight people must have at least two risk factors for obesity-related health problems to benefit from weight loss. But the revised guidelines find weight-loss dividends for people that have even just one risk factor, such as elevated blood pressure or high triglycerides (blood fats).

“The key message here is that we know weight loss isn’t just about will power,” said Donna Ryan, M.D., co-chair of the committee that wrote the guideline and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge. “It’s about behaviors around food and physical activity, and getting the help you need to change those behaviors.”

More Americans could benefit from statins

Cholesterol-lowering statin drugs should now be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. That’s according to a new cholesterol guideline from the American Heart Association and American College of Cardiology.

This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.

Statins are drugs that lower the amount of cholesterol circulating in the blood. Seven statin drugs are currently available in the U.S.

“We’ve been undertreating people who need statin therapy in this country,” said American Heart Association volunteer Donald Lloyd-Jones, M.D., one of 20 experts on the committee that wrote the new guideline.

Examples of groups that would exceed the 7.5 percent risk threshold and therefore benefit from statin therapy include white women over 60 who smoke and have high blood pressure and African-American men over 50 with high blood pressure.

“Statins lower cholesterol levels, but what they really target is overall cardiovascular risk,” said Lloyd-Jones, a preventive cardiologist and chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Ideally, the level of bad (LDL) cholesterol should be below 100 milligrams per deciliter of blood (mg/dL). It is considered high at 160 mg/dL. For someone taking a statin, the risk for a heart attack or stroke drops by about 20 percent for each 39 mg/dL reduction in bad (LDL) cholesterol, according to the guideline. Bad cholesterol is considered high at 160 mg/dL.

The guideline recommends statin therapy for the following groups:

People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
People with Type 1 or Type 2 diabetes who are 40 to 75 years old.
New risk equations add African-Americans and stroke risk

Doctors can now calculate cardiovascular risk in African-Americans for the first time ever. The new equations offer greater accuracy in predicting the chances of heart attack or stroke in African-Americans, whose risk levels are higher than whites.

But the new risk equations actually benefit everyone. That’s because for the first time, stroke risk has been added to the equation, giving patients a two-in-one assessment of their future cardiovascular health.

The updated risk equations for white men and women – and the brand-new risk equations for African-American men and women – were published in the risk assessment guideline from the American Heart Association and American College of Cardiology.

For decades, health providers have had to rely on risk equations based on long-term research in a white population – a group less at risk for heart attack and stroke than African-Americans. Doctors also often had to assess heart disease and stroke risk separately.

Healthcare systems and providers should adopt the new risk equations as soon as possible, said David Goff, Jr., M.D., Ph.D., who co-chaired a 17-member expert committee that wrote the guideline and an American Heart Association volunteer. “We believe the new equations are better because they are based on a broader, more current set of research data and assess both heart attack and stroke risk,” said Goff, dean of the Colorado School of Public Health in Aurora.

The new equations are recommended for 40- to 79-year-olds and measure a person’s risk for a heart attack or stroke within the next 10 years. A separate equation is available to estimate a person’s lifetime risk, which is recommended starting at age 20.

To calculate 10-year risk, the equation uses race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status. “That’s it,” Goff said. “Nothing that requires anything more than a visit to your healthcare provider and a fasting blood draw.”

About 610,000 Americans have a first stroke every year. Another 525,000 have a first heart attack. The good news is that the risks can be lowered through lifestyle changes and, in some cases, medications such as statins.

Talk to your doctor about the best strategies to lower your risk.

“You can’t do much about your risk if you don’t know what it is,” Goff said.

New guideline outlines the best dietary pattern and exercise for heart health

Americans shouldn’t sweat satisfying a sweet tooth with a slice of cake or ice cream every now and then. More critical to wellness is maintaining an overall heart-healthy dietary pattern than avoiding occasional indulgences, according to a new lifestyle management guideline from the American Heart Association and American College of Cardiology.

Just 40 minutes of moderate to vigorous aerobic exercise three to four times a week was also found to be sufficient for most people. Even brisk walking will do.

The new recommendations are designed for people who need to lower cholesterol and blood pressure. Many Americans fit that category: About one-third of U.S. adults have elevated levels of bad cholesterol, and nearly two-thirds have high blood pressure or prehypertension.

Recommended are dietary patterns that emphasize fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. Red meat and sugary foods and beverages should be limited. Many diets would work, including the DASH eating plan and plans suggested by the U.S. Department of Agriculture and the American Heart Association.

“Eating a healthy diet is not about good foods and bad foods in isolation from the rest of your diet – it’s about the overall diet,” said Robert Eckel, M.D., co-chair of a 19-member expert committee that wrote the guideline. Eckel is also a past American Heart Association president.

The overall dietary pattern should include less sodium, the guideline says. For people who need to lower their blood pressure, the guideline recommends an initial step-down approach to no more than 2,400 milligrams of sodium a day. Currently, the average American adult consumes about 3,600 milligrams daily.

Americans can lower blood pressure even further by getting sodium down to 1,500 mg a day. Cutting out processed foods high in sodium may be necessary to stay below that threshold.

“We all eat too much sodium, and this guideline provides further evidence that we’d all do well to eat less of it,” Eckel said.

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.

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