Statin Guidelines – The Fight Continues

It’s startling how much debate and disagreement exists about the guidelines for statin use.

Back in November 2013, new guidelines were published by the American Heart Association and the American College of Cardiology. The 2013 guidelines represented a significant shift in cholesterol management: essentially moving away from targeting/treating to a specific cholesterol level and instead encouraging treatment of all individuals with a 10-year risk of heart disease of 7.5% or higher (for specifics, see my post, The NEW guidelines for cholesterol-lowering statin meds).

There then ensued heated arguments over the published Risk Calculator that yields that all-important 10-year level of heart disease risk. Indeed, clicking the AHA’s Heart Attack Risk Assessment page right now yields this frustrating error:

“We’re sorry, but this tool is currently unavailable. The Heart Attack Risk Calculator is being updated and will be available soon. Please check back!”

Luckily, the AHA’s Prevention Guidelines page with a link to the original calculator still exists, so you can still calculate your 10-year risk. (Note: if these links fail, try my RESOURCES page: I’ll try to keep the risk calculator links up-to-date there.)

Assuming one believes at least directionally in the AHA’s risk calculator (and I do), it’s important for those who can use the calculator* and assess your personal level of heart disease risk over the next 10 years. (* You cannot use the calculator if you have heart disease or take statins already. Read more about calculators here.)

Until yesterday, it was clear what to do with your resulting risk: if someone between 40-75** gets a 10-year risk of heart disease of 7.5% or more, statin therapy should be considered and discussed with a doctor. (** See full 11/2013 recommendations below.)

But yesterday, things got a little tricky for anyone whose risk is between 7.5% and 10%.

Because yesterday, the U.S. Preventive Services Task Force issued new guidance for the use of statins which is not exactly the same as the AHA 2013 guidelines. (The USPSTF guidelines were published in the Journal of the American Medical Association; read/download a PDF here).

  • On the plus side, the new USPSTF guidelines support the November 2013 AHA decision in that the new guidelines are also based on the 10-year risk calculator. So the USPSTF added weight to the argument for using 10-year risk calculator, and not treating by managing to a particular LDL cholesterol level.
  • On the tricky side, the new USPSTF guidelines increased the risk of heart disease cutoff from 7.5% to 10%.

So now it’s not entirely clear what someone with a risk rate of 7.5%-10% should do. And whether insurance will cover statins for those individuals.

That’s because, as Ariana Eunjung Cha of The Washington Post astutely points out in her excellent article, New Statin Guidelines: Everyone 40 and older should be considered for the drug therapy, both Medicare and the Affordable Care Act use USPSTF recommendations to guide drug coverage plans. So that MAY call into question whether insurance companies will cover statin drugs for those in the 7.5% to 10% risk group.

In the end, what’s important is this: calculate your 10-year risk of heart disease. Use the calculator, and:

  • If you’re below 7.5%, make sure to keep pursuing a lo-co lifestyle with frequent exercise and a healthy, low-fat, low-sugar, plant-based diet.
  • If your risk is over 10%, get thee to a doctor and discuss statins.
  • If your risk is between 7.5% and 10%, talk to your doctor or cardiologist about what next steps are right for you.

It all starts with your risk: calculate it!  It’s so easy – all you need is your latest cholesterol results and systolic blood pressure (the first number).  Then review your personal results and make a plan with your doctor.

Supplement:
** November 2013 AHA recommendation: if you are in one of the following four groups, you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher.

The USPSTF November 2016 recommendation:
“The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (ie, symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are aged 40 to 75 years; 2) they have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater.”

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How Much Exercise For Boosting Heart Health?

Exercise is one of the key methods for lowering cholesterol – and blood pressure, my new concern — without medications. So to reduce my blood pressure and to continue to keep my cholesterol in check without any meds, I’ve been wondering just how much, how hard, and how often I need to exercise.

In researching, I found this nifty chart from the American Heart Association. It’s a little busy, but the key is the bottom-most graphic, which is for lowering cholesterol and blood pressure (how handy that they are together goal-wise!)

Apparently, to lower cholesterol and blood pressure, one needs to exercise for an average of 40 minutes at a ‘moderate-to-vigorous-intensity aerobic activity’ 3-4 days each week.

AHA Exercise Guidelines

Which sounds like kind of a lot, people.

I mean, I can jog for 20 minutes before my knees hurt – but certainly not 40 minutes (I was awed when my 21 year old son ran the Chicago marathon in 3 hours and 49 minutes. I still can’t believe he did that / that anyone can run for that long!).  So, um, 40 minutes of ‘moderate-to-vigorous’ exercise 3-4 times a week sounds like a LOT to me.

So obviously, the key question is – what is ‘moderate-to-vigorous-intensity’ aerobic activity?

To me, moderate-vigorous seems like it’d be exercise that gets my heart rate to hit at about 70-85% of my Max Heart Rate (for me, that’s 140-154 or so). If you want to know more about setting a personal heart rate goal, read How To Set A Simple Heart Rate Goal. But is that moderate or is that vigorous?

Luckily, the American Heart Association had a post that answered that exact question: Moderate to Vigorous – What is your level of intensity?  The AHA defines moderate and vigorous exercise as follows (link to the article for more detailed, pretty interesting info):

Examples of Moderate Intensity:

  • Walking briskly (3 miles per hour or faster, but not race-walking)
  • Water aerobics
  • Bicycling slower than 10 miles per hour
  • Tennis (doubles)
  • Ballroom dancing
  • General gardening

Examples of Vigorous Intensity:

  • Race walking, jogging, or running
  • Swimming laps
  • Tennis (singles)
  • Aerobic dancing
  • Bicycling 10 miles per hour or faster
  • Jumping rope
  • Heavy gardening (continuous digging or hoeing)
  • Hiking uphill or with a heavy backpack

Whew. I can walk quickly for 40 minutes to count as heart-healthy exercise. Yay – that’s one I can actually do!  But walking is kind of boring to me – and 40 minutes still feels like a lot of time.

So I need another option. One that’s vigorous but doesn’t eat into my day. Which is why I’m intrigued by High-Intensity Interval Training. In fact, this explanation of HIIT from Karen Reed of Positive Health Wellness was music to my ears, “Thanks to the non-stop, high-intensity pace of the workout, you can fit in both aerobic (cardio) and anaerobic (resistance training) exercise in just 15 to 25 minutes.” For more details, read her article, “All The Benefits of High Intensity Interval Training Workouts.”

I’d rather ramp up my exercise plan than go on blood pressure or cholesterol meds, so I’m looking at trying out High-Intensity Interval Training and/or scheduling more – or longer – aerobic exercise into my week. How about you?

 

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Heart Attack Symptoms in Women

A recent bout of acid reflux made me wonder about heart attack symptoms in women – I vaguely recalled that women (and men, but more often women) often don’t go to the Emergency Room with heart attack symptoms because they don’t want to be embarrassed to find that all they have is heartburn.

It can be a costly mistake. Especially for women.

Because heart attack symptoms can present differently for women than men. Both men and women can experience left arm pain along with crushing chest pain – like an elephant is sitting on their chest. But women are much more likely to be having a heart attack and not realize it because they are not having huge chest pain – and instead they are suffering with heartburn, dizziness, fainting, shortness of breath, nausea, and back &/or jaw pain.

According to the American Heart Association’s Heart Attack Symptoms In Women web page, they advise the following are “Heart Attack Signs in Women:

  1. Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
  2. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  3. Shortness of breath with or without chest discomfort.
  4. Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
  5. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

If you have any of these signs, call 9-1-1 and get to a hospital right away.”

This 3 minute film directed by and starring Elizabeth Banks illustrates how heart attack symptoms can look like for a fit, healthy woman:

Please know that a heart attack doesn’t have to feel like severe chest pressure — especially in women — and if you ever experience any of the signs of a heart attack, even if you are a fit, healthy woman, get to an Emergency Room.

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No Pots To Clean Gourmet Dinner

At our annual Cape Cod family vacation, I am responsible for serving the annual Fish Dinner for 10-15 people (there is also the annual Steak Dinner and the annual Lobster & Ribs Dinner, hosted by my brothers-in-law along with, The-Night-Everyone-Arrives-Baked-Ziti-Dinner my now 90-year-old mother-in-law whips up.)

Let’s be clear. Cooking for a very large group in an ill-equipped ‘cottage’ kitchen and serving it as a sit-down dinner in a too-small dining room is NO VACATION. It’s actually a potential nightmare. But it’s what we do. Every year. And once dinner’s on the table, it’s a blast… Plus, my wine-collector brother-in-law brings a LOT of wine so that’s, um, great. (I make sure to finish with all knife skills before imbibing – that’s another story that ends at the hospital).

Anyway, we’ve been doing this for years, but last Thursday I faced a fish dinner crisis: the only feasible date was our last night at the Cape – and we had to pack up our rental house and be on the road by 7:30 the next morning. I tried for a fish dinner hiatus. No dice (a huge compliment yet also frustrating). So I agreed to with one condition: I would cook but I would NOT host 12 people in the rental house that we were in the midst of packing up.

Once that was swiftly agreed upon, I had to devise a dinner plan. Usually my goal is a new variation on fish everyone will like. This year, my goal was: how to cook a full dinner for 12 with very little clean up. Like, none. Else we’d never finish packing and get out on time.

The answer: I devised a menu that required NO pots. Thus no clean up, and no ferrying pots, pans and serving utensils to and fro.

Amazingly, it was a huge success – both the cooking and the quick clean-up… but also, the dinner itself. There were actual accolades! My mother-in-law declared it, “your best fish dinner ever,” and someone dubbed it, “totally gourmet.” There were no leftovers and literally, we had NOTHING to clean up – all we had to do was load the plates and cutlery into the dishwasher. Oh, and the very many wine glasses.

The trick: a dinner plan that relied on heavy duty aluminum foil on the grill, sequential cook times, and ‘sauces’ prepared in advance.

Here’s what I prepared:

  • 2.5 pounds of Arctic Char and 1.5 pounds of Haddock that I prepped with olive oil, salt, pepper, herbs, slivered onions and halved cherry tomatoes: grilled in foil and served with two homemade sauces (really, dressings): Green Goddess and Mustard Vinaigrette.  I thought folks would enjoy trying two very different types of fish, which they did. And surprisingly, my favorite, Arctic Char, was the big winner! (See Lo-Co Recipe page for other fish/Arctic Char recipes!)
  • The fantastic “Grilled Potato and Onion Packages” recipe I found on epicurious.
  • Asparagus we grilled in the afternoon and served at room temperature.

IMG_2695Cooking fish in foil on a grill is dead-easy. All you do is place a fish fillet in foil (skin-side down, if it has skin), slick it both sides with olive oil, add salt and pepper and any fresh herbs you like (I used chives, thyme and rosemary). Atop that, squeeze some lemons and place some very thinly sliced lemon along with very thinly sliced onion and halved cherry tomatoes. The only truly ‘obligatory’ ingredient is olive oil and some lemon – but it makes a nice presentation with all these items! Then wrap it TIGHTLY in foil (I double wrapped it) and grill over medium-high or high heat for 10 minutes — longer if it’s a thick fillet. We needed 15-20 minutes for the 3 wrapped fillets. Take them off the grill and transfer to a serving platter – I removed the onion and lemon slices, but placed the tomatoes back on top for a pretty presentation. I like my fish plain but feared others would not, so I served the fish with choice of a Mustard Vinaigrette (David Tanis’ recipe on my Lo-Co Recipe page) and a Green Goddess dressing/dip mix from Penzey’s Spices that I had whipped up in minutes that morning.

The other element we needed to grill at my brother-in-law’s rental home was the phenomenal “Grilled Potato and Onion Packages” recipe I found on epicurious. Read the recipe and reviews online, or recipe PDF is here and also on my Lo-Co Recipes page. These, my husband and I prepped in the afternoon, then brought over 11 packages all ready to go on the grill!  While they’re meant to be served individually I just opened all 11 packages into a large serving bowl – either way is great.  A few notes from my read of the reviews and my experience making this fabulous and fabulously easy recipe:

  • I used baby red potatoes that I washed and left skins on – and cut into small pieces (like eighths!) so they’d cook quickly enough.
  • Instead of white, I used red onions – again cut into very thin slices – about same size as potatoes.
  • Use heavy duty foil – there’s a size that’s the right width the recipe calls for. 
  • Move the packets every 5-7 minutes or so – maybe 3 times for the 30 minutes – but don’t flip them – goal is to move so that no one spot gets too hot and burns.
  • It’s very easy BUT takes time to cut the potatoes and onions – leave plenty of time for all the slicing!
  • Even if you hate mustard, you won’t taste it here… and if you LOVE mustard, you need to increase the amount used.

The whole dinner took 1 hour to cook at my brother-in-law’s rental home (though a few hours to prep — and we did grill asparagus (see below for how) at home first and served it room temperature.) 

Once we landed at my brother-in-law’s I prepped the fish while my husband grilled the potato packets. In the end, it looked like this:

IMG_2698

 

 

IMG_2697Two notes on the finished dishes:

  • The fish fell apart, which doesn’t happen when you bake or cook fish directly on the grill. But it’s juicy and tender, and if you have enough wine, no one will notice.
  • The potato & onion dish looked much more appealing than this photo; I’d had a few glasses of wine by then…

Hope you try!  So easy and healthy and delicious – and no pots to wash!

To grill asparagus: soak for 10 minutes and snap off the tough bottoms, loosely dry, toss with olive oil, salt and pepper and put right onto a medium-high grill for about 10-15 minutes, rolling them to grill evenly.

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Healthy Sides For Summer BBQing

If you’re grilling up a nice, healthy fish dish for a summer get together (or even if you’re grilling steak or burgers) it can be a challenge to come up with tasty, healthy side dishes. This summer, I have two new favorites: Grilled Sweet Potato Fries and Broccoli Slaw.

I discovered Grilled Sweet Potato Fries on Health.com and it’s so easy and delicious that I’ve made these five times already this summer. It’s a great dish for 2-4 people: if you’re making it for a crowd, you’ll just need to budget your grill time to get a mound of fries done and turned!

The concept’s perfect for summer weather when you don’t want to heat your house with anything oven-based. Just wash and poke a few sweet potatoes, dry, and microwave on high for 6-7 minutes (more if the sweet potatoes are huge, though it’s much easier to use small-medium sweet potatoes!). Let them cool a bit, cut into wedges, and toss with olive oil, salt, pepper, and a seasoning of choice (recipe calls for paprika; I favor Penzey’s Balti seasoning or a paprika / cumin / chili pepper blend.)  Then grill on a medium-hot grill for 3-5 minutes per side.  Not only are they fantastic, they keep in the refrigerator pretty well – toast ’em on up next day in your toaster oven for fabulous side-dish leftovers. Link to web recipe above or download this PDF of Grilled Sweet Potato Fries.

What to serve with your protein and Grilled Sweet Potato Fries? How about a tasty broccoli slaw? The title of this recipe on ‘thekitchn.com’ compelled me to take a risk on a new recipe for a friend’s BBQ: Light & Easy Broccoli Salad. If you have a food processor (or can find broccoli slaw in a store) this is a snap to make. And testament to its tastiness: everyone asked for the recipe. It’s worth reading the comments on ‘thekitchn’ website – I successfully followed several recommendations and substituted dried cranberries for the currants. And as I failed in my quest for bagged pre-shredded broccoli, the only challenge was shredding it myself in my Cuisinart; it’s not hard but took me a while to figure out which blade to use. But once I got the broccoli shredding down, this recipe was very easy and with just 1/2 cup mayonnaise, far healthier than store-bought slaw. Check it out on thekitchn site and read the reviews and/or download this PDF of Light & Easy Broccoli Salad.

BroccoliSlaw_SweetPotatoFriesHere’s a picture of both along with a sad little piece of grilled pork – but don’t the sweet potatoes and broccoli slaw look enticing?

Hope this adds some variety and fun to your healthy summer dinners!

 

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