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New Guidelines for Heart Disease

Updated on December 21, 2019
Pamela99 profile image

After 22 years as an RN, I now write about medical issues and new medical advances. Diet, exercise, treatment, and lifestyle are important.

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Past Heart Disease Treatment

More than 17 million Americans have coronary arteries with blockages from plague (atherosclerosis). Over the past few decades a patient with chest pain typically received further cardiac testing. This can include a 12-lead EKG, a monitored exercise stress test or a chemical stress test. Cardiac catheterization with the possibility of cardiac stent placement or even open-heart surgery would follow for any significant abnormalities. The concern is that people with stable heart disease could be treated with medications instead of quickly having the more advanced procedures.

Of course, stent placements and surgeries have risks and they are very expensive. In addition, a person that has had stent placements must be on an anticoagulant medication from 6-12 months, which also carries a risk. The surgery takes a considerable amount of recovery time as well.

New Research

A recently completed study that spanned 37 countries had a budget of $100 million. The study resulted in new guidelines for the treatment of heart disease. This study did include patients with severe cardiovascular disease. Researchers found that the risk of having a heart attack or dying over the years was not reduced following heart surgery or having a stent implanted in an artery of the heart.

The study found that after one year the invasively treated group (7%) had a cardiac event as compared to 5% of those on medication alone. In 4 years 15% of the group on medications had a cardiac problem, while only 13% of the group who had procedures had a cardiac event.

Treadmill exercise tests were given to 5,179 participants who had problems with cardiac blood flow. All of the participants were given medications to improve their heart health, and they were also given healthy lifestyle advice. Approximately one half of these participants were given a CT scan to rule out blockages that were dangerous.

The people who showed more severe blockages had a cardiac catheterization, and they were treated with angioplasties, cardiac stents or surgery if necessary. Additionally, if a person had a heart attack they received a procedure immediately to restore blood flow.

New York University’s Dr. Judith Hochman stated that non-emergency cases do not need to rush into having any invasive testing and medications should be given a chance to work. Another result of this large study found a higher rate of more severe heart problems or death in those participants who had a cardiac procedure during the past year.

Treatment of 100% Blocked Coronary Arteries

Cardiac Procedures

The medical procedures for a blocked artery in the heart include:

  1. Angioplasty - a cardiac catheterization that uses a tube to push through the blockage while inflating a balloon that expands the plague to open the artery
  2. Stent placement - during a cardiac catheterization a stent is placed in the blocked artery to restore blood flow
  3. Open heart surgery - the surgery uses the mammary artery or other arteries harvested from the legs to bypass the blocked section of the coronary artery

There was study completed 12 years ago which showed that angioplasty was not more effective than treating patients with medications. Many doctors did not agree with the methods of this study, so treatment overall did not change.

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New Recommendation Based on Study

An effective strategy includes a team-based care approach to prevent cardiovascular disease. Each individual should be evaluated for cardiac disease risk factors.

Recommendations include:

  • Statin therapy is considered the first line of defense as high cholesterol, particularly low-density lipoprotein (LDL) that should be below 190 mg/dl for those with diabetes mellitus between 40 and 75 years of age.
  • Aspirin is used infrequently as a routine primary prevention aid.
  • Blood pressure ideally is 120/80. If your blood pressure consistently runs above 130/80 medication is used to lower it to a healthier level.

You might wonder why medication works better than a cardiac procedure in reducing future cardiac events. The reason is a stent or angioplasty only treats a small section of a coronary artery, so if you have plaque in your arteries other areas of the artery may present a problem in the future.

Cardiac Disease Risk Factors

There are numerous new and improved medications to treat the problems with heart disease. Cardiac procedures do improve chest pain, but not longevity. Chest pain improved after procedures alone, but it may be a placebo effect.

Cardiac risk factors include:

  • A family history, which cannot be changed (ASCVD for males under 55 years and females under 65 years that may include high cholesterol)
  • Metabolic syndrome where your waist circumference is increased, including elevated triglycerides above 150 mg/dl, an elevated blood pressure and a low good cholesterol (HDL) below 40 for men and 50 for women.
  • Chronic kidney disease (eGRF 15-59 mL/min) with or without albuminuria untreated with dialysis or kidney transplant
  • Chronic inflammatory diseases, such as RA, psoriasis, systemic lupus or HIV/AIDS
  • History of premature menopause (before age 40 yr)
  • Adults with type 2 diabetes mellitus
  • Race/ethnicity risk factor (South Asian ancestry)
  • Consistent elevated hypertriglyceridemia (above 175 mg/dL, nonfasting)
  • Obesity as it promotes other diseases, such as diabetes type 2

Healthy Foods
Healthy Foods | Source

2019 Prevention Guidelines

The American College of Cardiology (ACC) and the American Heart Association (AHA) have set clinical practice guidelines since 1980, which are based on scientific evidence. First, counseling and caloric restriction is recommended for overweight adults.

  1. Exercise of 150 minutes a week of moderate-intensity or 75 minutes of "vigorous-intensity” is recommended.
  2. Adults with type 2 diabetes mellitus are evaluated for lifestyle changes, such as dietary habits and exercise recommendations.
  3. Adults will be assessed for tobacco use, and they will be strongly advised to quit.
  4. Statin medication is a first-line medication for elevated cholesterol.
  5. Aspirin is infrequently used for the routine primary prevention.

It is important to promote a healthy lifestyle and a “team-based approach” is considered the most effective way to prevent cardiovascular disease. Adults from 40 to 75 years of age will be evaluated for cardiovascular disease prevention by undergoing a risk estimation for cardiovascular disease prevention. The patient should have a discussion with their physician before any pharmacological therapy is started, such as statins, aspirin or antihypertensive medications. The physician will also assess for other risk factors, and they may order coronary artery calcium scanning if warranted as it is a non-invasive test.

Other recommendations include:

  1. A healthy diet for an adult should include vegetables, fruits, nuts, legumes, whole grains, lean meats and fish. The diet should minimize processed meats, trans fats, sweetened beverages and refined carbohydrates.
  2. Blood pressure should be less than 130/80, so non-pharmacological treatment will be tried before prescribed medications.

Truth: You Can Reverse Heart Disease

In Summary

Cardiovascular disease should be treated in a more conservative fashion. Procedures will be scheduled as necessary but medications will be the first line of defense. It is still important for patients to know the signs of a heart attack and report any symptoms to their physician.

Expereince with Cardiac Disease

Have you or a family member had a cardiac event or an invasive procedure?

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This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2019 Pamela Oglesby

Comments

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  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    10 months ago from Sunny Florida

    Devika, I appreciate your comments, as always.

  • DDE profile image

    Devika Primić 

    10 months ago from Dubrovnik, Croatia

    Hi Pamela this is important and often needed in one's life. You have thought of this health issue and created a well-written hub. A must read.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    17 months ago from Sunny Florida

    Hi Raymond, I am glad you found this article interesting and your comments are appreciated.

  • raymondphilippe profile image

    Raymond Philippe 

    17 months ago from The Netherlands

    Thanks for this well written article. You sure did your research. I found it very interesting to read.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    17 months ago from Sunny Florida

    Hi Ruby, The new treatments for heart disease are fantastic. These procedures mean you do not have to have open heart surgery, which is wonderful Of course, Mayo Clinic is wonderful also.

    I appreciate your very generous comments.

  • always exploring profile image

    Ruby Jean Richert 

    17 months ago from Southern Illinois

    This is a very important article and written well. My husband Ray had a mitral valve in the heart that was leaking blood. We flew to Mayo Hospital and they put a clip on the valve, ( A new procedure ) He is doing well. mayo is the only place to have this done, and they have only been doing it for five years, although, I heard that Indy is going to start soon. They go up through the groin to place the clip. It's amazing what can be done.

  • Robert Sacchi profile image

    Robert Sacchi 

    17 months ago

    Yes, it does. Thank you again,

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    17 months ago from Sunny Florida

    Hi Robert, Yes, aspirin was one of the standards and I think those with a hisory of heart disease should still take an aspirin. If your are taking a blood pressure os cholesterol medication but have not had any problem with your heart, then I think they say aspirin is not necessary. I hope that clears up the new study for you. I appreciate your comments.

  • Robert Sacchi profile image

    Robert Sacchi 

    17 months ago

    It seems aspirin was the standard preventive medication for many years. It seems they have decided it wasn't worth the effort.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Thank you for commenting, Robert.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Vivian, The guidelines changed very recently. I thik we will see more people treated with medicine before the doctor orders more extensive testing or treatments. I appreciate your comments, Vivian.

  • Noelle7 profile image

    Vivian Coblentz 

    18 months ago

    I didn't realize the guidelines had changed, so it was interesting to read the updates. I didn't realize a stent only treated a small section, which explains why so many doctors advise patients to take aspirin.

  • Robert Sacchi profile image

    Robert Sacchi 

    18 months ago

    Appreciate your posting.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Robert, I appreciate your comments.

  • Robert Sacchi profile image

    Robert Sacchi 

    18 months ago

    Thank you for another informative article about health care.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Linda, I appreciate your very nice comments and I am glad you find my articles useful and interesting. Thanks for commenting. Have a very Merry Christmas!

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Audrey, I am sorry to hear about your father. Diabetes is definitely a risk factor. Lifestyle is certainly important. I appreciate your comments, Audrey. I hope you have a Merry Christmas!

  • vocalcoach profile image

    Audrey Hunt 

    18 months ago from Idyllwild Ca.

    I lost my father to a heart attack, probably brought on by diabetes, or a stroke. He did not have any prior heart procedure done. I agree with the importance of living a healthy lifestyle and taking meds if needed to avoid these procedures.

    Thanks for this great update. Have a wonderful Christmas!

  • AliciaC profile image

    Linda Crampton 

    18 months ago from British Columbia, Canada

    Thank you for sharing this information, Pamela. I'm always interested in reading about the latest medical research. Your articles are useful as well as interesting.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Flourish, I wonder if age or something else, like a medication or a procedure, has caused her dementia. She must be aware of the dementia to make that comments so i imagine it frustrates her at this time.

    I appreciate your comments about your grandmother. Have a Merry Christmas, Flourish!

  • FlourishAnyway profile image

    FlourishAnyway 

    18 months ago from USA

    My grandmother has had several heart procedures including being in a small number that received an experimental new surgical procedure several years ago. I was therefore very interested in this article. Her very skilled surgeon told her she’d die of something but it would not be a bad heart. We noticed after the surgery that her mind got considerably foggier so that now her heart beats but her dementia is not good. Even she will tell you it’s not a good existence.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Ms Dora, I presented the latest information I found and I am glad you found it informative. Thank you for your comments.

  • MsDora profile image

    Dora Weithers 

    18 months ago from The Caribbean

    You made your point that medications are better in the new treatments for heart disease. This is a life and death matter and I appreciate the information and explanations. Thanks for sharing.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Liz, I am not sure about eggs, but I would think they are a lot healthier than bacon or some other fatty meat. Statins and aspirin have been prescribed for heart patients for a long time, but they found in this study that aspirin wss not helpful. I am not quite sure how they could know that for sure.

    I am glad you found the article informative and I appreciate your comment

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Maria, I am glad you found all of the articles informative and helpful. I like the direction of the care for cardiac patients also. I appreciate your comments, as always. Love and hugs.

  • marcoujor profile image

    Maria Jordan 

    18 months ago from Jeffersonville PA

    Hi Pamela,

    This is a wonderful update - reinforcing the value of reversing factors in our control (food choices, movement, etc...) for a healthier heart.

    I also appreciate the inclination to try medications before resorting to medical procedures.

    Thanks for this catch-up morning of three most informative articles.

    Love and Merry Christmas,

    Maria

  • Eurofile profile image

    Liz Westwood 

    18 months ago from UK

    This is an interesting and well-researched article. In the UK first line treatment is with statins and aspirin. But many also have surgical procedures. It is amazing how much heart surgery has advanced. At one time guidance was to limit egg consumption as it caused increased cholesterol levels. Then eggs were deemed okay to eat. So now I'm not sure where to go with eggs.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Alyssa, Things for heart patients sure aree changing, and I think they are changing for the good. Thank you so much for your very nice comments.

  • Alyssa Nichol profile image

    Alyssa 

    18 months ago from Ohio

    Wow! Those results were surprising! It's eye-opening that the invasive procedures aren't as effective and interesting that doctors are moving away from Aspirin. I always enjoy reading your medical articles and learning something new. Excellent article!

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Clive, The Nano technology may be great in the future, at least I hope so. As for the cardiac events in the 7% group, there is always a bit of the unknown. There was a large age range in the group and you don't know if they did follow a heart-healthy diet or if they exercised. Thanks so much for your comments.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Doris, You and your husband have sure been through a lot. I guess you are grateful for each day together now. I hope you can get your blood pressure under control. A woman should get the same attention as a man. Thank you so much for your comments, Doris. Have a very Merry Christmas!

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Venkatachari, Not having cornary artery disease is good news. Treating your blood pressure is easier and stomach problems are very treatable as well. I appreciate your comments.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Lorna, The advancements for cardiac issues is wonderful for the future. I appreciate your very nice comments. Merry Christmas and Happy New Year Lorna!

  • Lorna Lamon profile image

    Lorna Lamon 

    18 months ago

    I have quite a few family members who would have benefited from the advancements made in the treatment of cardiac issues today. An excellent and informative article Pamela well written. Have a wonderful Christmas Pamela and a peaceful and Happy New Year.

  • Venkatachari M profile image

    Venkatachari M 

    18 months ago from Hyderabad, India

    Very useful and interesting information. You have provided some good facts and tips for dealing with heart disease and important guidelines for keeping it under control.

    I am also a heart patient with my BP controlled within the 130/80 range. Once I complained of some inconvenience in breathing with some tightness in the chest. They conducted an angiogram and there was no fault in the arteries. So, it was simply due to some gastric trouble. Heart medicines often cause gas problems.

  • MizBejabbers profile image

    Doris James MizBejabbers 

    18 months ago from Beautiful South

    Good article, Pamela. It really is amazing how cardiologists are changing their approach to dealing with heart problems. I started keeping up with this when my husband of one-year had the "big one" and I nearly lost him. After that, I started fixing healthier foods, but that didn't cure him of his bad eating habits. As a result, he's had bypass surgery, stents, and now a pacemaker. He nearly died twice before they could get the pacemaker installed, and today he is probably living on borrowed time.

    On the other hand, my MVP has healed and I have no plaque in my arteries, but my doctors ignored my high-blood pressure until I had a stroke. I was on two HBP meds and now I'm on three, and my PC is still complaining that it is high. That's closing the barn door after the horse has gotten out. Funny what it takes for a woman to get medical attention.

  • clivewilliams profile image

    Clive Williams 

    18 months ago from Jamaica

    Those are pretty interesting stats. So even 7% evasively group still experienced cardiac event. But what are the age and health factors of these individual; why this occurred I hope one day Nano technology will be at a stage where it can be used to repair anything in and out the human body..

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi MG, I am glad you found thid article informative. Thank you for your comments.

  • emge profile image

    MG Singh emge 

    18 months ago from Singapore

    One of the most informative articles I have read. Thank you Pamela for widening my knowledge. God bless you.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Linda, Your daughter has a fairly common problem that is controlled with medicine most of the time. There is a good chance she will be just fine.

    I appreciate your comments, Linda. Have a Merry Christmas!

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Ruby, I am glad you have no heart problems. Thank you for your nice comments. Have a Merry Christmas!

  • always exploring profile image

    Ruby Jean Richert 

    18 months ago from Southern Illinois

    It is good to learn the latest info. on heart disease. I am lucky, no heart problems. Thanks for sharing. Interesting and well written.

  • Carb Diva profile image

    Linda Lum 

    18 months ago from Washington State, USA

    Pamela, this is one area where medical advancements have been amazing. My older daughter has tachycardia which is controlled with medication. I hope she doesn't require intervention as she gets older.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Bill, That is probably true as there are many significant advancements for sure. You are fortunate to be so healthy. Thanks for your comments. Have a very Merry Christmas.

  • billybuc profile image

    Bill Holland 

    18 months ago from Olympia, WA

    It is pretty amazing, the advances in cardiac treatments. My dad died fifty years too soon. They probably could have successfully treated him today.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi Eric, It sounds like you are all doing the right things to stay healthy. I know there has been stress since the accident but the love along with the group hugs sounds like a healing time. I appreciate your comments, Eric, and I wish you and your family a very Merry Christmas.

  • Ericdierker profile image

    Eric Dierker 

    18 months ago from Spring Valley, CA. U.S.A.

    My wife is perfect for this. Exercise and a change in diet. A CT Scan to "rule out". Not driving for a bit. (the stress of driving is interesting) More group hugs and a bit of reduction in work.

    We do not do passive here in our home. We get after it. No meds. Just vigorous adaptation. The change in foods has been great.

    Thanks for this, it will help us focus.

  • Pamela99 profile imageAUTHOR

    Pamela Oglesby 

    18 months ago from Sunny Florida

    Hi John, I thought this particular study had a good result as doctors will be less agressive when someone could be treated with medications rather than a procedure with possible risks.

    I am glad you have had no heart problems. A pacemaker doesn't really have anything to do with blocked arteries, so you may never have a problem. It is still good to know the symptoms of a heart attack and to get help if necessary. I appreciate your comments.

    I hope you have a very Merry Christmas, enjoying the heat from what I hear. LOL

  • Jodah profile image

    John Hansen 

    18 months ago from Queensland Australia

    Thank you for sharing this information, Pamela. It is always great to know the latest changes in regard to medical procedure and how diseases are being treated. I have had no cardiac problems so far (touch wood) but my father did (had pacemaker fitted) and also one uncle on my mother’s side.

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