My title is intended to have more than one meaning, but I’m simply recording the latest advise from the heart health experts.

Gina Kolata wrote this piece for the New York Times: http://www.nytimes.com/2013/11/13/health/new-guidelines-redefine-use-of-statins.html?pagewanted=all

The article is informative with good links.

“The architects of the guidelines say their recommendations are based on the best available evidence. Large clinical trials have consistently shown that statins reduce the risk of heart attacks and strokes, but the committee concluded that there is no evidence that hitting specific cholesterol targets makes a difference. No one has ever asked in a rigorous study if a person’s risk is lower with an LDL of 70 than 90 or 100, for example.”

What I understand so far is that cholesterol isn’t proving to be all it was cracked up to be. I’ve always said cholesterol is a symptom, not a cause. Still, I’m no doctor, nor heart health researcher, so I surely don’t know, and my opinion is held loosely.

Heart disease is significant and personal to me. With five young children, the youngest merely 10 weeks old, my wife had a blockage (twice) of the left anterior descending artery. It was a rough three weeks.

I learned a lot during that period. What I would most hope everyone will learn before such a dire circumstance, is take your own health seriously and personally, and be sure you have a close friend or loved one with you who feels just as passionately. No one cares but you and your companion. Really. Own that fact. It is the fundamental fact of life. We walk alone, with very few exceptions.

Study your drugs. Discuss with your doctors, nurses, druggists, and loved ones. Look everything up, mostly on the medical and science sites. Take everything else with a grain of salt.

Don’t get me wrong, without exception, the medicine-related personnel I’ve dealt with all care and show honest compassion. But when I spent the first few days by my wife’s side, and nearly the entire three weeks constantly with her, the nurses were all amazed, more than one pointing out that she would not be sharing her pay for my assistance. They knew they could simply not show such devotion. Grandparents and friends made it possible, and having built up some vacation time helped as well, but the fact is we can seldom count on anyone to show such devotion in such critical times of need.

So, educate yourself. Study up. Talk with your doctors. It is all the more critical in these tumultuous times in health insurance and rule and regulation uncertainty. Mind the paperwork and the permissions. Take the time to get to know the key medical personnel who will be able to show flexibility in crunch time. They only have so much wiggle room. Make sure they won’t need much. Get the paperwork completed. The personal touch also goes a long way in keeping tensions low when you are having to press for what you think is right, even when you are making your own decisions for yourself.

A couple of things I keep in mind: most of us will die of cardiovascular disease or failure of one variety or another, mostly MI, like what almost got my wife. Thank God she is quite well still. The other thing I keep in mind is that we all die young. It is most certainly a tragedy when the young die, but it really is only easier to take, and no less tragic, when someone dies honorably after a long and fruitful life. Long is so relative, and we will live longer than anything else we do, whether it be measured in minutes, years, decades, or even centuries.

The references:

http://content.onlinejacc.org/article.aspx?articleid=1770218

The full report:  http://content.onlinejacc.org/data/Journals/JAC/0/11003.pdf

2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Robert H. Eckel, MD, FAHA; John M. Jakicic, PhD; Jamy D. Ard, MD; Nancy Houston Miller, RN, BSN, FAHA; Van S. Hubbard, MD, PhD; Cathy A. Nonas, MS, RD; Janet M. de Jesus, MS, RD; Frank M. Sacks, MD, FAHA; I-Min Lee, MD, ScD; Sidney C. Smith, MD, FACC, FAHA; Alice H. Lichtenstein, DSc, FAHA; Laura P. Svetkey, MD, MHS; Catherine M. Loria, PhD, FAHA; Thomas W. Wadden, PhD; Barbara E. Millen, DrPH, RD, FADA; Susan Z. Yanovski, MD

J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.11.003

http://content.onlinejacc.org/article.aspx?articleid=1770220

The full report:  http://content.onlinejacc.org/data/Journals/JAC/0/11005.pdf

2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

David C. Goff, MD, PhD, FACP, FAHA; Donald M. Lloyd-Jones, MD, ScM, FACC, FAHA; Glen Bennett, MPH; Christopher J. O’Donnell, MD, MPH; Sean Coady, MS; Jennifer Robinson, MD, MPH, FAHA; Ralph B. D’Agostino, PhD, FAHA; J. Sanford Schwartz, MD; Raymond Gibbons, MD, FACC, FAHA; Susan T. Shero, MS, RN; Philip Greenland, MD, FACC, FAHA; Sidney C. Smith, MD, FACC, FAHA; Daniel T. Lackland, DrPH, FAHA; Paul Sorlie, PhD; Daniel Levy, MD; Neil J. Stone, MD, FACC, FAHA; Peter W.F. Wilson, MD, FAHA

J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.11.005

From the American Heart Association and the American College of Cardiology, here is the referenced risk assessment tool:

http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

http://static.heart.org/ahamah/risk/Omnibus_Risk_Estimator.xls

From the page: Further details regarding the derivation and validation, and strategies for implementation, of the risk assessment algorithm are available in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk and the Full Report of the Risk Assessment Work Group.

There are other links on the page, including this:  http://static.heart.org/ahamah/risk/Prevention_Guidelines_Clinical_Vignettes.pdf

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