Intensify treatment for heart patients

By Steve Sternberg, USA TODAY

Mounting evidence that scores of heart patients can avoid second heart attacks or strokes with intensive treatment to reduce their risks prompted the nation's two top heart organizations on Monday to jointly issue new prevention recommendations.

The two groups call for more routine use of high-potency statins to lower bad cholesterol (low-density lipoprotein or LDL). They recommend expanding the use of other drugs that lower blood pressure and ease the heart's workload. They also, for the first time, back seasonal flu shots for all chronic heart disease patients.

"That's a really important major new recommendation," says Sidney Smith, of the University of North Carolina-Chapel Hill, and chairman of the American Heart Association and American College of Cardiology group that issued the guidelines.

Because new studies also show that lower aspirin doses are just as effective for prevention as higher ones, the guidelines recommend dropping daily doses to between 75 milligrams a day and 162 milligrams, except in patients who have had bypass surgery. Bypass patients fare best on 100 to 300 milligrams a day for up to a year.

The so-called secondary prevention guidelines could affect as many as 26 million people in the USA who have survived heart attacks and strokes and those with chronic coronary heart disease, Smith says.

They don't address primary prevention, or what to do for people who don't yet have heart disease.

Multiple studies show that "aggressive, comprehensive risk-factor management" boosts survival, prevents second heart attacks and strokes, reduces the need for bypass surgery and balloon angioplasty and improves the quality of life for heart patients, the authors write.

"Thanks to the clinical trials, we have definitive proof on all these things, which we can't say for primary prevention," says Robert Califf, director of the Duke University Clinical Research Institute, who is not one of the authors but who is familiar with the guidelines.

Califf says primary prevention studies are far more difficult to carry out because they require tens of thousands of low-risk people and may take decades to yield clear results. For instance, he says, the Women's Health Initiative study failed to prove something that most people take for granted: that a low-fat diet helps healthy women prevent heart attacks and strokes.

"If you're 30 years old and your LDL cholesterol is a little high, common sense would tell you that it might be good to treat it (with medication), but we don't know, because the evidence isn't in," Califf says.

"If you're 70 years old, and you've got a high LDL and you've already had a heart attack, your risk of something bad happening is so high, aggressive treatment makes sense," he says. "We've got the proof."

LOWER RISK FOR A SECOND ATTACK The American Heart Association and American College of Cardiology guidelines, endorsed by the National Heart, Lung, and Blood Institute, set targets for six key risk factors: Eliminate cigarette smoke, including secondhand exposure. Lower blood pressure to 140/90 in most heart patients and 130/80 in patients with diabetes or chronic kidney disease. Lower LDL to less than 100 milligrams per deciliter of blood. The guidelines also say it's reasonable to aim lower, to 70 milligrams per deciliter. Boost exercise levels to 30-60 minutes seven days a week, up from 30 minutes three or four days a week. Shrink waistlines, men to less than 40 inches and women to less than 35 inches. If you have diabetes, keep your average blood sugar level to 7% or below. http://www.usatoday.com/news/health/2006-05-15-statins-heart_x.htm