The debate over new heart disease prevention guidelines proposed by U.S. cardiologists is being stirred.
In Tuesday’s issue of the medical journal The Lancet, a U.S. doctor and a researcher call the American Heart Association and American College of Cardiology’s new guidelines a step forward but point to flaws in applying its risk calculator.
In their commentary, Dr. Paul Ridker and Nancy Cook of the Center for Cardiovascular Disease Prevention at Boston’s Brigham and Women’s Hospital raised questions about applying the guidelines for primary prevention in people without a history of heart disease, stroke and few risk factors.
Unlike the previous guideline that focused on cholesterol levels, the latest edition uses a risk calculator based on factors such as age and high blood pressure. But estimates from the new calculator were roughly double the actual heart attacks or strokes observed in three major cohort studies, Ridker and Cook said.
“Reliance on the new risk prediction algorithm could put many primary prevention patients on [cholesterol lowering] statin therapy where there is little trial evidence while potentially denying the drug treatment to others where there is evidence,” the pair said in the commentary.
Every minute counts for heart attack victims. The amount of necrosis in the heart tissues increases as they are starved of blood flow during the attack. When damage is extensive and large sections of the heart die, heart attack survivors are at high risk for a second event — which can be heart failure, irregular heart rhythms or sudden death.
Protecting the heart after heart attack was the goal of Valentine Fuster, MD, PhD, and colleagues who are working toward a new, faster treatment for heart attack victims — published this month in the journal Circulation. They completed a multi-center heart attack study in Spain at the Centro Nacional de Investigaciones Cardiovasculares Carlos III, CNIC, in collaboration with the Icahn School of Medicine at Mount Sinai in New York. Dr. Fuster is director ofMount Sinai Heart as well as general director of CNIC and the Physician-in-Chief at The Mount Sinai Medical Center.
The investigators injected the patient with a beta-blocker drug, metoprolol, in the ambulance on the way to the hospital — within 10 minutes of the patient’s heart attack. Guidelines recommend treatment within 24 hours with a pill form of metoprolol in order to reduce damage to the heart. The patients who received the early intervention had significantly better outcomes when their heart function was measured over the next 5 to 7 days.
Everyday Health spoke with Dr. Fuster to highlight the success of this new treatment, and any risks associated with it, along with a look at his plans for future studies.
Everyday Health: Is there any way to predict who is most at risk for having a heart attack?