ApoB and Cardiovascular Risk

In Cholesterol Tests Your Doctor Hasn’t Told You About, I briefly describe a cholesterol blood test for Apolipoprotein B (ApoB).  This simple blood test measures the number and size of LDL (bad) cholesterol: it’s an important test if you have high LDL (bad) cholesterol or are at ‘high risk’ of cardiac disease, as it provides a more finely tuned assessment of cardiovascular risk.

In fact, it might be a critical test for those with low LDL (bad) cholesterol – because it can reveal hidden cardiac risk.

While studies show ApoB is a better predictor of cardiac risk, it is not yet a test that is widely prescribed. Indeed, the American Heart Association is waiting for more studies to determine if ApoB is a test doctors should recommend. Personally, I find this frustrating (of course this means nothing as I’m not a doctor, but…) To me, it’s frustrating because this is a simple blood test that provides a detailed risk assessment.

Scientific American’s Heart Health Special Report entitled ApoB – A Better Marker For Heart Attack Risk Than LDL-Cholesterol explains why it’s an effective and important test:

“A high level of low-density lipoprotein (LDL, or “bad”) cholesterol is an important risk factor for a heart attack. Yet about half of the people who develop coronary heart disease have normal or even low LDL cholesterol levels. Some research suggests that a component of LDL—called apolipoprotein B, or apo B—may be more accurate at predicting coronary heart disease.

A Limitation with LDL Cholesterol Testing
The problem with using LDL cholesterol levels to determine heart attack risk is that the test measures only the amount of cholesterol in the LDL cholesterol particles, not the number or size of these particles. Apo B measurements, on the other hand, provide information on the number of LDL cholesterol particles.

For example, people with a higher apo B value than LDL cholesterol value tend to have smaller, denser LDL cholesterol particles. Studies have shown that small, dense LDL cholesterol particles are more strongly associated with heart attack risk than large, “fluffy” LDL cholesterol particles.

The test itself is a simple blood test. It’s easy and cheap: easier, even than the standard cholesterol lipid panel as it does not require fasting.  In fact, the test can be done in conjunction with a standard lipid panel.

Finally, after I visited a cardiologist, I got the ApoB test and my results were, of course, mixed.

Ha! ha ha ha ha ha ha ha

Part of the problem is that since ApoB testing isn’t a standard test there is conflicting info on what the goal ApoB levels should be. My cardiologist was happy with my results because my ApoB is lower than my LDL level, my LDL Pattern is the far healthier Type A / Fluffy LDL, and because my C-Reactive Protein was low risk (more on C-Reactive Protein and LDL patterns in another post.).

But my actual lab report shows my ApoB level of 123 as ‘high risk’ and simply references a desired range of 49-103.  So at 123, I have ‘high’ ApoB.

Ruh Roh.

Who to believe?

Well, it’s simple.  My cardiologist. After a lot of online research (again, I’m no doctor so take all this with a grain of salt), I think the reason my cardiologist is OK with my ApoB score of 123 is because of all those elements I mention above AND ALSO because  I fall into the ‘low risk’ of cardiac disease segment. It turns out that there are different ApoB goals based on a person’s general cardiac disease risk, and the lab report seems not to take this into account.

ApoB goals by risk pool is well explained in Medscape’s emedicine article entitled Apoliprotein B article, in the chart here:

Screen Shot 2015-03-14 at 5.22.44 PM

 

Since my 10 year risk factor via the cardiac disease risk calculator is low (and I also have just 1 risk factor from the ‘old’ way of calculating risk), then it’s probably OK that my ApoB is 123 as it’s lower than 130.

I’m glad I got the ApoB test done – but it’s only because I asked two doctors for it.  If you want a more detailed risk assessment, ask your internist or cardiologist about ApoB testing.

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Slow Cooker Part Deux…A Failure and A Find

A prevalent pet peeve is how Facebook distorts reality.  It’s far too easy to conclude that everyone except you is having SO much fun…because no one posts pics about staying home alone … or how it’s a bummer to see pics of parties to which you’re not invited… or, well, all that kind of stuff.

That got me thinking about recipe blog posts.  It’s an apt corollary; the majority of recipe blog posts are about successes.  Indeed, I do it too — to date, all my recipe blog posts have been about recipe successes.

So with this post I am bucking the trend.  Because this post is about a lo-co cooking failure. And I think that it’s an important topic because cooking lo-co is tough enough without the false belief that everyone else’s dishes turn out well all the time. Because they do NOT.

Case in point: last week I tried a slow-cooker recipe for Char Siu Pork Roast that had huge promise, but that failed.  Miserably.  Actually, it was absolutely awful.

This dish was so appalling I threw it out and ate cereal for dinner. Worse, I could not get the stench of this dish out of my house fast enough (challenging when it’s sub-freezing outside, but open the windows I did!)

I was particularly disappointed in Char Siu Pork Roast because: a) the recipe was from Cooking Light, and I (now nearly) always have good luck with their dishes; b) it was listed in an article with the promissory title of, “100+ Slow-Cooker Favorites“; and c) there were 108 reviews and it got four stars.  FOUR STARS. OUT OF FIVE. (I went back and looked to see if it was four starts out of ten, but nope, out of five).

I don’t know who these 108 people are, but man, they have different tastebuds than I do. Not only that, my easy-going husband didn’t like it either.  The problems were many, IMHO.  The 5 spice flavor was overwhelming; several ingredients seemed to flavor-fight with each other; and worst of all, it was dry dry dry.  I guess I should have paid more attention to the several reviewers who panned this recipe; my POV was eerily similar.

So.  A lo-co failure.  I should have taken a photo, but basically could not throw out this food fast enough!

And then – another fail – I bought a pork tenderloin a few days later but accidentally grabbed one that was seasoned with pepper when what I wanted was plain.

Sigh.  I am not a fan of peppercorn-marinaded anything.

pressure-29744_640But I didn’t want to throw away a perfectly good (though not my taste) pork tenderloin, so that inspired a search for a slow-cooker recipe that would mask the massive pepper. I readied the cereal boxes in case it was another failure… but was pleasantly surprised last night with “The Best Crock-Pot Pork Tenderloin” dish. Especially since the recipe was from a site I’d never seen before (usually I only cook from Cooking Light or Epicurious).

The site WhiskingMama.com must have really great SEO — the only reason I clicked on this recipe is that it was the #1 result in search for ‘pork tenderloin crock-pot recipe.” I decided to try it because I already had the (wrong) tenderloin, these ingredients looked like they’d cover up the pepper, and I happened to have all the ingredients on hand (with a few substitutions: dijon for yellow mustard and garlic cloves instead of garlic powder).

I forgot to take a photo, but this dish was easy, quite tasty, and while it might not be the “best” crock pot pork tenderloin recipe ever (I mean, who’s to judge?), I’d make it again. We’re planning leftovers for dinner tonight, actually – so the cereal’s been put back in the pantry for breakfast.

Here’s the recipe for “The Best Crock Pot Pork Tenderloin” if you prefer a PDF to clicking on the link above.  I made it with a 1 pound tenderloin instead of 2 pounds, and just read this morning in Sam Sifton’s A Simmer View of the Slower Cooker article that I should have cut the marinade in half. His quote refers to different recipe/ingredients but the basic tenet is the same:

“The most important thing is not to have too much liquid in the pot. For a small slow cooker, use a smaller cut of meat and a proportionately smaller amount of fish sauce, hoisin and water.”

I will make this Crock-Pot Pork Tenderloin again, this time with regular rather than the despised peppered tenderloin, and will either cut the marinade in half OR will make it with 2 pounds of tenderloin because it was delicious enough to want leftovers.

So a recipe to avoid – and one to try!  Feel free to send me your lo-co recipe failures or favorites!

 

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A Thai Lo-Co Crock-Pot Winner

Before today’s blizzard that thankfully didn’t hit where we live in CT (strange to be thankful for 6″ of snow and counting), the weather last Saturday was atrocious. I had decided to try a new crock-pot recipe so we would be treated all day to the enticing aroma of curry while stuck inside catching up on a long list of household chores.

And it both looked and tasted delicious. Which is a big thing, because my easy-going husband usually does not enjoy crock-pot casseroles.  A huge shame given the easiness of crock-pot cooking, but there you go.

But this one was a hit. On the plus side, it was relatively easy and quite flavorful. On the down side, it uses beef.  I may try again with chicken but had decided a little beef on a cold, miserable day seemed a fine plan.  And while it does have more cholesterol than I usually go for (50 mg/serving) that really isn’t too bad.

Thai Red Curry CrockPotThe recipe was from Cooking Light – my go-to for new, healthy recipes – and it was in an article entitled, 100+ Slow-Cooker Favorites. Truth be told, I wasn’t sure we’d like it as I’ve tried a few I didn’t love from recipes in this trove, but gave it a go and was glad I did. My plate of Thai Red Curry Beef didn’t look as pretty as the picture on the recipe, but hey, I’m no food photographer. What I can tell you is that it was quite tasty.

If you like curry, give this a try. Before you do, be sure to read the recipe and ALSO read the reviews so you can adjust to your taste, especially vis-a-vis spiciness.  A few things I’d suggest if you give it a go:

  • I used one whole jalapeño with seeds because we like very spicy – and it was very, very spicy.  When I make again, I’ll use only half the seeds …
  • Based on the reviews which said the sauce was thin, I debated dusting the beef with cornstarch before browning it as some suggested.  But that seemed hard. So instead I made a cornstarch and cold water ‘slurry’ (same as if making gravy) and spooned that in after the spinach. Easy and effective.
  • They don’t say to use cubed stew meat – but that’s what the picture looked like so that’s what I did. Buy or cut the meat ahead of time, even though that’s not in the recipe.
  • I did dice some carrots as you’ll see in my photo above (but not in the recipe photo) and that worked well. I cut 4 carrots into relatively big bites and added them when the crock pot had about 1 hour left.  They were great – not mushy; cooked just through.
  • I wish I’d added mushrooms.  Will do next time.
  • I bought freshly diced onion from Trader Joe’s to save time and highly recommend that. Probably would NOT use frozen diced onions as they’d release too much water to a broth that some considered watery.

For today’s blizzard-that-wasn’t I bought some fresh arctic char which I enjoyed last night with several glasses of wine… See recipe for Baked Arctic Char on my recipes page. So easy, healthy and delicious.

For tonight, we’re having chicken breast with bok choy and quinoa. I wish instead I’d bought a whole chicken to roast: my friend Michaela (a talented author who prefers writing to cooking) raves about this whole roast chicken recipe, which I keep meaning to try. She just emailed me to say, “You should try. It is fabulous and I’m an indifferent cook at best! But the bird is completely juicy and the skin crunchy.”  OK, the skin is a lo-co no no, but still – I bet it’s great. And with a name like How To Make The Best Roast Chicken Of All Time – and with video instruction on how to truss a chicken – how could you go wrong?

I’ll let you know about the whole roast chicken – but if you like curry and are of a crock-pot mindset, give Thai Red Curry Beef a shot.

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New Year’s Exercise Resolutions and Heart Health

If you’re like most Americans, getting more exercise is on your list of New Year’s resolutions.

And for good reason: exercise is one of the key methods for lowering cholesterol – and blood pressure, my new concern — without medications.  Oh, and that dropping weight side-benefit (ha ha) is kind of fantastic, too.

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 like exercise and exercise more frequently than most people I know, and that sounds like a lot to me.

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

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

I found this useful, but prefer a more specific goal: for me, moderate-vigorous means my heart rate hits 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.

Since the only thing I do for exercise that lasts more than 30 minutes is walking or spin class, all this means I need to be a bit more, um, diligent about working out. Sure, I play tennis 2-3 times per week, power walk on nice days (3 miles at about 4 mph) and take spin classes – but I’m pretty clear that I’m not hitting the 40 minutes part of the 3-4 days per week goal.

But I’d rather ramp up my exercise plan than go on blood pressure or cholesterol meds, so I’m looking at scheduling more – or longer – aerobic exercise into my week. How about you?

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Cholesterol Results 2014

So I finally bucked up and got my cholesterol tested in November and the results were surprising.  First of all, my cholesterol – after a year of reasonably careful eating and a lot more exercise, but no Metamucil or Fish Oil pills – actually moved in the right direction.

Details in a second.

Not only that, my new cardiologist (again, more in a sec on why I needed to finally see a cardiologist) actually called my cholesterol results “enviable.”

Enviable, people.

This shocked me. Especially because I gave up on the fish oil pills which apparently now, in a total turnaround from past belief, don’t help much with cholesterol. (It’s frustratingly difficult to keep up with what’s recommended –  and what is no long considered effective – for managing cholesterol without statins.)

That said, in the face of a genetic predisposition toward high cholesterol, I’ve managed through diet and exercise to avoid cholesterol medication.  Though truth be told, that’s more likely due to the American Heart Association’s 2013 revised Guidelines For Managing Blood Cholesterol than anything I’ve done… if the Guidelines hadn’t been revised, I’d probably still be having the statin conversation with my doctor.

In any case, here are my exciting (ha ha) cholesterol results.

My overall cholesterol is UP and now measures 246 – which used to be considered high but is apparently now not so big a deal.  Not a big deal, I guess, because my LDL (bad) cholesterol keeps falling (“goal” is less than 130 and mine is now 123) and my HDL (good) cholesterol keeps rising (“goal” is higher than 46 and mine shot up to 95).

NOTE: I put “goal” in quotes because these goals are no longer really in line with the new Guidelines; I find it fascinating that they are still reported as “goal” when the only goal according to the new guidelines is LDL (bad) cholesterol over 190 along with other heart disease risk factors that have nothing to do with cholesterol results.  Bizarre that this is still ‘outdated’ a year later.  Or maybe not bizarre, just sad.

In any case, I’m excited about the results.  Here’s a chart for those who prefer graphs.  If that’s not you, skip to cardiologist discussion 2 paragraphs below!

KLS Chol Trend Thru 2014

You’ll see the red line of total cholesterol is still high and rising – but no one seems worried about that, since the green line of LDL (bad) cholesterol is falling along with the purple triglyceride line … and because the blue line of HDL (good) cholesterol is rising.

Things certainly do change – I’m so glad I never started on a statin back in 2010-2011 when my numbers looked like a statin was in order.

Now, on to cardiologist.  My cholesterol results were surprising – and nicely so. But at same blood test I found I am positive for a blood clotting disorder, so that was a major bummer.  It’s not treated – and not dangerous unless you take hormones (which of course I was) so that had to stop immediately.

And then it turns out my blood pressure has risen quite dramatically.

Likely the stress of this past year – along with wondering and worrying about the blood clotting disorder.  Hence my doctor-referred trip to the cardiologist.

So my new cardiologist and primary care doctor are sorting out how to deal with my (hopefully short-lived) blood pressure issue … and on the plus side, I really liked the new cardiologist.  And when we discussed cardiac risk and my cholesterol trends and family history, he also thought that getting a handle on what my cardiac risk really looks like is a good idea.  So I had two more blood tests – and YAY – these are the very tests I’ve written about thinking made sense for me in Cholesterol Tests Your Doctor Hasn’t Told You About.  Finally!

So I had blood tests for both C Reactive Protein (CRP is a measure of inflammation in the body and high levels have been associated with heart disease) and also a full lipid analysis that will measure LDL density, ApoB and more.  I am really relieved to finally be getting a handle on cardiac risk.  Lastly, am debating about getting a Coronary Calcium test done – it’s a CT test so there’s radiation involved (and Aetna denied coverage) so I’ll likely wait until the blood test results come back to decide.

So on plus side, my cholesterol tests are now ‘enviable’ but am waiting for the blood test results to come back and really help hone in on cardiac disease risk. Oh, and trying to figure out how to get my blood pressure back to normal.

So I’ll end 2014 with a question for you: how’s your cholesterol? And, um, blood pressure? If you don’t know, please resolve in 2015 to have them checked.

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Vote For A Healthier, Tastier Thanksgiving Sweet Potato Dish

In last week’s New York Times, Kim Severson wrote about a recipe originally created by Regina Charboneau called Sweet Potatoes With Cranberry-Jalapeño Chutney.  I decided I had to try this for two reasons: a) I recently learned my mother-in-law adores baked sweet potatoes, which are incredibly easy to prepare (and it’s always a good plan to get on the in-laws good side, no?) and 2) the description of this dish promised it was both easy and that it can be made a week ahead, key for Thanksgiving:

“This is an easy and surprisingly delicious way to get a dramatic-looking sweet-potato dish on the Thanksgiving table with little fuss…  Make the chutney up to two weeks ahead and keep it in the refrigerator. It also freezes well. Assembly on Thanksgiving is an easy last-minute task.”

So I made this last week and other than finding black currants (regular supermarkets seem to have only something called Zante currants – and they are not what you want, apparently, for this recipe), it was both easy and delicious.

Not only is this elegant, delicious recipe easy to prepare (and prepare ahead, key for Thanksgiving), it is a far healthier alternative to the traditional Sweet Potato Casserole with Marshmallows.

I entered both recipes into the My Fitness Pal Recipe Importer, and here is the not-at-all surprising result.

  • A half potato serving of Kim Severson’s Sweet Potatoes With Cranberry-Jalapeño Chutney – even WITH sour cream (which is not even needed, IMHO), is just 214 calories with 7 grams of fat, and it’s loaded with Vitamin A and C because it’s, um, a real food.
  • A serving of “Traditional Sweet Potato Casserole” (from MyRecipes.com) packs 731 calories and 23 grams of fat!

Even if you ate an entire huge sweet potato with a huge amount of chutney (a double serving if you will), you’d still be at about HALF the calories and fat than the marshmallow casserole.  HALF.

Sweet Potato Nutritional Comparison

Luckily, I am not a fan of the Sweet Potato with Marshmallow dish so am not tempted (don’t talk to me about gravy though!)  But here’s an idea — this Thanksgiving, serve both. See if you can convert to a new healthier (and frankly tastier) sweet potato dish for Thanksgiving.

Three preparation tips:

  • Buy the red onion and peppers already diced.  I was thrilled to find in Stop & Shop one package that had red onion and 3 colors of bell peppers freshly,beautifully diced – it saved a ton of time, and I just ditched the yellow pepper portion.
  • This recipe makes a virtual VAT of chutney.  Halve the chutney recipe and you’ll have more than enough for 12 servings.  (Note: I adjusted the serving size in the nutritional value calculations.)
  • This chutney gels in the refrigerator – make sure to take it out hours ahead to get back to the proper chutney consistency.

HOST A FAMILY CONTEST!
For my Thanksgiving this year, since the marshmallow casserole is a ‘must’ I decided to have a contest – I’m going to ask everyone to vote for which sweet potato recipe is best, with the hope of a healthier new dish for our annual feast.

First, I assigned the task of bringing the traditional (fat-laden) Marshmallow Sweet Potato casserole to one of the people who insists it’s necessary. My plan is to serve that, and right next to it, feature the Kim Severson dish — and include the nutritional info for both right at the buffet table. Then we’ll have a taste-off. (We have a wildly competitive family – if they can vote, they’ll participate!)

Sound like fun? If you also want to have a contest, just click on the chart above and it’ll open a PDF that you can print – then you can just lay that out next to these two dishes at your Thanksgiving table this year, in the hopes of a new, healthier Thanksgiving tradition.

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New Chart Helps Identify Heart Disease Risk

The National Lipid Association (NLA) recently released an ‘infographic’ that, according to the person who contacted me on behalf of the NLA, is intended “to help people better understand their cholesterol to help reduce the risk of heart attack and stroke.”

And indeed, I think it’s a very useful chart.  Essentially, it helps you visualize your heart disease risk by turning the major risk factors into a series of easy questions; these questions help determine your heart disease risk and serve as a basis for discussion with your doctor:

NLA Infographic FINAL

You can also find this chart on the National Lipid Association’s “Learn Your Lipid” site.

As I wrote about in both The NEW Guidelines For Cholesterol-Lowering Statin Meds and also, New Cholesterol Guidelines – An App For That, when the American Heart Association published the new cholesterol guidelines in November 2013, there was a new focus on determining a person’s 10-year risk of heart disease rather than treating LDL (bad) cholesterol to a specific level.  In broad strokes the new guidelines state that 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.

What’s great about this NLA chart is that it works in tandem with the new guidelines – and helps people easily see if they are at risk. Net, this infographic quickly flags those who may fall into risk groups #2 or #4 above.

For example, for risk group #2, using the NLA infographic will ensure you know your total cholesterol – so you can see if LDL cholesterol is 190 mg/dL or higher and thus at risk.

And for risk group #4, the questions asked by the NLA infographic help you determine (without using a calculator!) if you might be at an elevated risk of heart disease.  That’s because the questions asked in the chart (if you smoke, are overweight, have diabetes and/or high blood pressure, etc) are the very factors that feed into the AHA’s 10-year risk calculator.

So have a look at this chart and if you answer ‘yes’ to the items in step 1, make sure you have your total cholesterol checked and talk to your doctor about your heart disease risk.

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Why High Cholesterol Increases Heart Disease Risk

In my role as cholesterol “Category Expert” for www.answers.com, I recently answered a question sent in by an Answers reader that I was surprised to find I’d never expressly addressed here on my blog:  “Why does high cholesterol lead to heart disease?”

Here’s the answer I posted: you can read it on this page of wiki.answers.com, or I’ve pasted it here as well:

Once you look at the definition of cholesterol, it’s easy to see why high cholesterol can cause heart disease.

The National Institute of Health defines cholesterol as, “a waxy, fat-like substance that’s found in all cells of the body.” Cholesterol in and of itself is not bad – in fact, your body needs some cholesterol to make hormones and vitamin D, and your body makes all the cholesterol it needs. But sometimes genetics and/or eating high fat foods and not getting enough exercise results in overly high cholesterol levels. 

When you have more cholesterol than your body needs, the waxy, excess cholesterol can build up and stick to the artery walls – that’s called plaque. When plaque forms, there is a significant increase in risk of two heart disease problems — stroke and heart attack — because plaque can break open and cause a blood clot. A stroke happens when a blood clot blocks an artery that feeds the brain. A heart attack is the result when plaque or a blood clot blocks an artery that feeds the heart.

So while having high cholesterol alone used to be cause for treatment to stave off heart disease, as of the new November 2013 guidelines, now high cholesterol by itself is not THE big risk factor. Rather, the latest treatment standard is to factor high cholesterol in with other heart disease risk factors to determine overall risk of stroke and heart attack.

 

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Cholesterol Treatment – Guidelines Pocket Cards for Doctors

Did you know that any old person (and by ‘any old’ I mean a regular, non-doctor person, not any OLD person!) can purchase the American Heart Association’s “guidelines pocket cards” meant to keep doctors up to date on latest treatment protocols/recommendations?

On the American Heart Association website, these pocket cards are described as:

“These quick reference tools provide instant access to current AHA/ASA and ACCF/AHA guidelines in a clear, concise format – available in print and in the Guideline Central Mobile app for iPhone, iPad and Android.”

AHAlogo_lifeiswhy-logoFor months, I have been wondering whether there have been any updates or changes to the November 2013 Cholesterol Guidelines – and how doctors are following – or not – the new guidelines. (More info about the 2013 guidelines here: The NEW guidelines for cholesterol-lowering statin meds).

To me, there’s been a startling dearth of information about how treatment of high cholesterol has changed – or not – since these guidelines were issued. So I was pleased to stumble upon these pocket guidelines for doctors – updated with the latest recommendations.  For just $8.99 I downloaded the cholesterol pocket guidelines and found them largely unchanged since the new guidelines were issued in November 2013.

Which is good, I guess.

That said, one new thing I learned from this pocket guide is that there are established goals for the more in-depth cholesterol tests like C-Reactive Protein and Coronary Artery Calcium – both tests I think I might benefit from.

While my $8.99 purchase would NOT let me print (grr), I was able to grab some text via the handy iPhone app. Love that.

So if you would like a peak at the ‘pocket guidelines’ your doctor may well use when considering how to treat your high cholesterol, read on. Fair warning: it’s, um, quite detailed and uses acronyms (it is, after all, for doctors) so I’ve included a simple glossary for some of the medical terms.

Here goes – what follows is the ‘key points’ section of the doctor ‘pocket guide’ for treating high cholesterol:

TITLE: Cholesterol Adult Management

KEY POINTS

  • Encourage adherence to a heart-healthy lifestyle. A healthy diet, regular aerobic physical activity, smoking cessation and maintenance of a healthy weight are critical components of ASCVD risk reduction. Control hypertension and diabetes, when present.
  • Statin therapy is recommended for adults in groups demonstrated to benefit. ASCVD risk reduction clearly outweighs the risk of adverse events based on a strong body of evidence in 4 groups:
    • Secondary prevention in individuals with clinical ASCVD
    • Primary prevention in individuals age ≥ 21 years with primary elevations of LDL-C ≥ 190 mg/dL
    • Primary prevention in individuals with diabetes 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
    • Primary prevention in individual without diabetes and with estimated 10-year ASCVD risk ≥ 7.5%, 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
  • Statins have an acceptable margin of safety when used in properly selected individuals and appropriately monitored. If no baseline abnormality, monitoring of hepatic transaminases is not routinely needed. CK should not be routinely measured unless there is a personal or family history of muscle problems. You may need to discontinue and then restart the statin to determine the cause of muscle symptoms.
  • Engage in a clinician-patient discussion before initiating statin therapy, especially for primary prevention. Discuss the potential for ASCVD event reduction, adverse effects, drug–drug interactions, and patient preferences. Additional factors may be considered when a risk-based decision is uncertain.
    • These include LDL-C ≥ 160 mg/dL, family history of premature ASCVD, hs-CRP ≥ 2.0 mg/L, CAC ≥ 300 Agatson units, ABI < 0.9; lifetime risk of ASCVD.
  • Use the newly developed Pooled Cohort Equations for estimating 10-year ASCVD risk. Calculating the estimated 10-year ASCVD risk should be the start of the clinician-patient discussion and should not automatically lead to statin initiation.
    • For other ethnic groups, use the equations for non-Hispanic whites, although these estimates may underestimate the risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and may overestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans).
  • Initiate the appropriate intensity of statin therapy to reduce ASCVD risk.
  • Evidence is inadequate to support treatment to specific LDL-C or non–HDL-C treatment goals. “Treating to goal” may result in treatment with less-than-optimum statin intensity or adding unproven nonstatin therapy.
  • Regularly monitor patients for adherence to lifestyle and appropriate intensity of statin therapy. Obtain a fasting lipid panel before and after initiating statin or other drug therapy.
  • Nonstatin drug therapy may be considered in selected individuals.”

Going Lo-Co GLOSSARY:

  • ASCVD -atherosclerotic cardiovascular disease
  • Hypertension – high blood pressure
  • Statin Therapy – treatment with statin drugs, like Lipitor
  • Individuals with clinical ASCVD  – people with cardiovascular disease or who have had a ‘cardiac event’ like a heart attack
  • LDL-C – level of LDL cholesterol in the blood
  • 10 year ASCVD risk – risk of a cardiac event in 10 years, as measured by the calculator issued with the November 2013 guidelines.  More here: Going LoCo Calculator Post
  • hs-CRP – measure of “C-Reactive Protein” which is a marker for inflammation
  • CAC – coronary artery calcium which measures the thickness of fatty accumulation in the arteries and is used to predict heart disease risk

While managing cholesterol down to a specific goal is no longer the treatment standard, that doesn’t mean you shouldn’t be tracking your cholesterol and managing non-dangerous/risky high cholesterol with lifestyle choices. And remember, if your LDL cholesterol is at/over 190 mg/dL or you have other risks, discuss a statin with your doctor.

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Answers Q&A

As you may know, as “cholesterol expert” I’ve written many articles for Answers.com, which you can find in two places. First, on the cholesterol page of the Answers.com site. Also I have all the articles listed by title on the “Answers.com Published Articles” page on this Going Lo-Co site.

And now, new news…

This week, Answers.com added a new page to their site: a Q&A with me.  Of course, if you have cholesterol questions, you can always email me/comment right here on the Going Lo-Co site. But now you can also ask me a question (but not, of course, for medical advice!) on the all new www.answers.com/karenswanson site.

Just mentioning…

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