Understanding New Heart Disease and Heart Health Guidelines

The American Heart Association (AHA) and American College of Cardiologists released new prevention guidelines in November 2013 for physicians to help their patients avoid heart disease and stroke. “These guidelines are the result of experts poring over hundreds of clinical research studies and then developing recommendations about what works best,” reports AHA. The new guidelines focus on four areas:  Cholesterol, obesity, lifestyle, and risk assessment.


“Much of the conversation around these new guidelines has surrounded the recommendations for statin usage. Statins are medications that physicians prescribe to patients to help lower their cholesterol,” says Gopinath Upamaka, MD, FACC, a cardiologist with ProMedica Physicians.

Dr. Upamaka explains that the guidelines recommend that more patients may benefit from taking statins than previously thought. This includes people with:

  • Known heart disease:  You’ve already had a heart attack or a stroke.
  • Type 1 or Type 2 diabetes: And, you are 40 – 75 years old.
  • High cholesterol: You are 21 and older with bad (LDL or low density lipoproteins) cholesterol of 190 mg/dL or higher.
  • 7.5 percent or higher risk for heart attack or stroke within 10 years: Physicians use an equation to figure out your risk. See “Risk Assessment” below for more information.

Dr. Upamaka adds, “The guidelines also encourage physicians to stop focusing so much on the exact level of a patient’s cholesterol. Even with statins, diet and exercise, some patients may never lower their cholesterol to target levels. The key is to get patients on a moderate or high dose of a statin for the general protective powers of this medication.”

The cholesterol guidelines also recommend that some patients may benefit from higher doses of statins. And, research shows that adding non-statins like fish oil and niacin to treatment plans does not provide additional protection to patients.


Through these guidelines, obesity is now viewed as a disease. It encourages healthcare providers to actively help patients achieve or maintain a healthy weight.

Risk assessment

Many physicians already use a risk assessment equation, like the Framingham Risk Calculator, to determine a patient’s risk for having a heart attack within the next 10 years. To calculate risk, these equations typically use gender, age, cholesterol levels, blood pressure, use of blood pressure medication, diabetes status. and smoking status.

As part of these guidelines, AHA has developed a new risk assessment that also considers race and predicts your risk for having a stroke. The assessment is recommended for 40- to 79-year-olds. In addition, they produced a separate equation to estimate a person’s lifetime risk for use with patients starting at age 20.


The guidelines recommend setting goals for patients that help them maintain an overall heart-healthy lifestyle that includes:

  • Following a low-fat, low-salt diet: Dr. Upamaka recommends the Mediterranean or DASH diets to his patients.
  • Exercising 40 minutes three to four times a week: Brisk walking is a great choice for many patients, shares Dr. Upamaka
  • Stopping smoking

Key take-away

“Your ongoing relationship with your physician is really your key to mitigating your risk for a heart attack and stroke,” offers Dr. Upamaka. “These guidelines are helpful. But they are just that – guidelines. It’s most important that patients have personal conversations with their physicians to decide what is right for them.”