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Considering Statin Eligibility for Older Patients

Considering Statin Eligibility for Older Patients

Recently, the American College of Cardiology and American Heart Association (ACC/AHA) updated guidelines in the United States for treating cholesterol, shifting the recommendations to allocate statins to those with a high absolute risk for cardiovascular disease (CVD). “The guidelines recommend using statins for people with CVD, diabetes, or high cholesterol levels,” explains Michael D. Miedema, MD, MPH. “They also advise clinicians to use these medications in patients without these conditions but with a higher than 7.5% risk of heart attack or stroke in the next 10 years based on risk calculator data.” The updated guidelines represent a paradigm shift from the Adult Treatment Panel (ATP) III recommendations. The ATP III guidelines relied heavily on levels of LDL cholesterol to determine who to treat. The ACC/AHA guidelines recommend using statin therapy on patients who are at highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits. Examining the Impact of New Statin Guidelines A recent study estimated that the ACC/AHA guidelines will lead to significant increases in statin use, largely because more adults aged 60 and older without CVD or diabetes will be eligible for these medications. Dr. Miedema says it is important to look at the effect that the ACC/AHA guidelines will have on older patients because they may be prone to adverse effects with statin use. “It can be challenging for clinicians to determine whether or not statins should be used in older, healthy patients,” he says. In a research letter published in JAMA Internal Medicine, Dr. Miedema and colleagues analyzed the potential effect of the updated ACC/AHA guidelines and contemporary use...
Transformative Leadership Begins with Self-Development

Transformative Leadership Begins with Self-Development

If healthcare leaders want to transform our healthcare system so it is truly patient-centered and cost-effective and if we are serious about creating a culture of health in which we are preventing diseases long before they result in sickness, the place to start is with ourselves. All healthcare leaders—no matter whether you practice in a small office or a large hospital—because more often than not, physicians set the tone. But what you may not realize is that your mental and emotional state has a significant effect on the people around you. In his book Primal Leadership: Unleashing the Power of Emotional Intelligence, psychologist Daniel Goleman revealed: “The actions of the leader account for up to 70 percent of employees’ perception of the climate of their organization.”[1] Leading Means Showing the Way Unhappy, dysfunctional leaders cannot create high-functioning, compassionate practice environments, and a stressed out, unhealthy organization cannot take care of the health of others. So as physicians, we need to ensure that the effect we have on others is positive and beneficial. As leaders: ♦ If, when facing a problem, we display thoughtful intelligence rather than anger or frustration, we will inspire that behavior in others and promote creative solutions. ♦ If we are trustworthy and nurture a culture of trust, our colleagues will feel safe enough to communicate honestly, therein creating an environment in which real change is possible. ♦ If our words and actions demonstrate a deep commitment to cost effective, patient care, others will follow our lead, resulting in an improved practice environment. ♦ If we hold ourselves accountable for the vision and if we foster...
Lifestyle Strategies for Heart Risks

Lifestyle Strategies for Heart Risks

In 2013, the American Heart Association and the American College of Cardiology published a first-ever joint clinical practice guideline on lifestyle management to reduce cardiovascular disease (CVD) risks. Published simultaneously in Circulation and the Journal of the American College of Cardiology, the guideline is based on a systematic evidence review from studies published between 1990 and 2012. It summarizes key nutrition and physical activity topics for managing blood pressure (BP) and cholesterol. Healthy Eating & Physical Activity “To lead a lifestyle that can reduce CVD risks, heart-healthy eating habits and physical activity are paramount,” says Robert H. Eckel, MD, who co-chaired the expert writing group that developed the guidelines. To lower cholesterol, the guideline strongly recommends limiting saturated fat and trans fat. To lower BP, an emphasis is placed on restricting sodium to no more than 2,400 mg/day. Further reductions of sodium intake to no more than 1,500 mg/day are linked to an even greater reduction in BP. “Eating a heart-healthy diet is more about the overall diet rather than isolating specific foods that are eaten,” adds Dr. Eckel. A heart-healthy diet should focus on fruits, vegetables, and whole grains and include low-fat dairy products, poultry, fish, and nuts. It should also limit red meat, sweets, and sugar-sweetened beverages. “Following this pattern should help limit the intake of saturated fat, trans fat, and sodium to the recommended levels,” Dr. Eckel says. Adaptations to heart-healthy diet plans should be considered based on each person’s caloric requirements, personal and cultural food preferences, and nutrition therapy for other health conditions, such as diabetes. The guideline also recommends moderate- to vigorous-intensity aerobic exercise,...
Guidelines for Treating Blood Cholesterol

Guidelines for Treating Blood Cholesterol

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a new clinical practice guideline for the treatment of blood cholesterol in patients at high risk for atherosclerotic cardiovascular disease (ASCVD). The guideline was prepared by a panel of experts based on an analysis of the results of randomized controlled trials. The guidelines use the highest-quality scientific evidence to focus the treatment of blood cholesterol to those who are likely to benefit most. A Focus on Statins According to Neil J. Stone, MD, who served as chair of the expert panel that wrote the guideline, the ACC/AHA guidelines represent a departure from previous recommendations. “The guidelines don’t recommend specific target levels of LDL cholesterol,” he says. “Instead, they focus on defining patient groups for whom LDL lowering with statins has been proven to be most beneficial.” The panel recommended use of statins after a detailed review of other cholesterol-lowering drugs. “Most statins are generics and have been shown to provide the greatest benefit while having low rates of safety issues when taken as prescribed,” Dr. Stone says. The guidelines note, however, that there is a role for other cholesterol-lowering drugs in selected patients who suffer side effects from statins. The guidelines identified four major groups of patients for whom statins have the greatest likelihood of preventing stroke and heart attacks. Moderate- or high-intensity statin therapy is recommended for patients. 1. With clinical ASCVD. 2. With primary elevations of LDL cholesterol of 190 mg/dL or higher. 3. Aged 40 to 75 with diabetes and LDL cholesterol levels between 70 and 189 mg/dL without clinical ASCVD....
Voodoo

Voodoo

“I don’t care what the internet says. I’m sure there’s another explanation for your recurring pain besides voodoo.”  ...
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