Recommendations to Treat Heart Disease Continually Changing

Dr. David Lipschitz
Wed, 11 Mar 2015 21:00:00 -0700
Lifestyle

Research on how any disease should be prevented or treated is confusing, and what seems to be the gospel for a long period of time may suddenly change. This particularly applies to preventing and managing risks of heart attack and stroke.

Most remarkable is information related to coffee. In a report published in the journal Heart, researchers from Johns Hopkins Bloomberg School of Public Health followed 25,000 healthy subjects living in South Korea. The results showed that drinking five cups of coffee daily was associated with significantly less buildup of calcium in arteries, suggesting a lower risk of developing heart disease. The researchers also suggest that coffee may reduce the chances of developing diabetes. They note that the 2015 Dietary Guidelines Advisory Committee suggested that drinking coffee has minimal effects on the heart. The benefits of coffee were still present in smokers and in those with diabetes, high blood pressure, elevated cholesterol and obesity. The study could not identify the factors in coffee that led to benefits.

Though coffee may hold some benefit, it is still prudent to limit caffeine intake because of negative effects on sleep, heart rate and nighttime urination.
Updated: Thu Mar 12, 2015

Research on how any disease should be prevented or treated is confusing, and what seems to be the gospel for a long period of time may suddenly change. This particularly applies to preventing and managing risks of heart attack and stroke.

Most remarkable is information related to coffee. In a report published in the journal Heart, researchers from Johns Hopkins Bloomberg School of Public Health followed 25,000 healthy subjects living in South Korea. The results showed that drinking five cups of coffee daily was associated with significantly less buildup of calcium in arteries, suggesting a lower risk of developing heart disease. The researchers also suggest that coffee may reduce the chances of developing diabetes. They note that the 2015 Dietary Guidelines Advisory Committee suggested that drinking coffee has minimal effects on the heart. The benefits of coffee were still present in smokers and in those with diabetes, high blood pressure, elevated cholesterol and obesity. The study could not identify the factors in coffee that led to benefits.

Though coffee may hold some benefit, it is still prudent to limit caffeine intake because of negative effects on sleep, heart rate and nighttime urination.

Recent dietary guidelines suggest that cholesterol intake is not a major risk factor for heart disease or other illnesses. We can now be much more liberal in egg and shellfish consumption. Though more cholesterol is acceptable, intake of the wrong fats — including saturated animal fats, trans fats and omega-6 fatty acids — must be kept to a minimum. Guidelines place much greater emphasis on reducing added sugar, refined grains and salt intake. The guidelines are no longer enthusiastic about lean meat, as our diet already contains twice as much protein as we need.

Not surprisingly, greater intake of fruits, vegetables, whole grains, fat-free or low-fat dairy products, and seafood is encouraged. Overeating is highlighted as a major concern, and balancing calorie intake with activity levels is encouraged. Greater fruit and vegetable intake appears to reduce heart attack risk by as much as 40 percent.

The health benefits of alcohol are being questioned. It seemed as if the link between moderate alcohol, especially red wine, intake and improved heart health and longevity was concrete. Alcohol itself, by reducing stress levels, and resveratrol in red wine, by its antioxidant properties, were thought to be effective in reducing heart attack risk and promoting a longer life. But in past reports, former drinkers have been classified as nondrinkers. That and poor scientific methodology may have accounted for the seemingly obvious benefits of alcohol. A better study just published in the British Medical Journal examined 53,000 adults in the U.K. who completed a survey. In this study, which most agree was done rigorously, moderate alcohol intake (no more than two drinks daily) only benefited men between the ages of 50 and 54 and women older than 65. And the benefit did not seem to be so great as previously thought.

Doctors have also been overestimating heart attack risk. Advancing age, male gender, smoking, diabetes, high blood pressure, high HDL cholesterol and low LDL cholesterol were thought to accurately predict heart attack risk in the next 10 years. But a study just published in the Annals of Internal Medicine says the calculators doctors have been using tend to overestimate heart attack risk by 86 percent in men and 67 percent in women.

And there are new recommendations for cholesterol lowering using statins. A target for LDL cholesterol of below either 100 or 70 is no longer important. Those who have had a heart attack or an LDL level above 190 should receive treatment with a higher dose of a statin to lower LDL by 50 percent. For those with diabetes but no history of heart disease and an LDL level of less than 190, a lower dose of a statin is suggested. Low doses of a statin should also be used in those with no history of heart disease but whose future risk is significantly increased.

What should we make of these myriad changes and new recommendations? Most important is being prudent. Eat the right foods in the right amounts. (Don't worry so much about eggs and shellfish.) Exercise. Avoid stress. And be empowered to learn as much as possible about risk reduction of heart disease. Make sure to discuss it with your doctor.