Are new guidelines setting us up for failure?

Are we destined for failure when it comes to heart disease?

With recent guideline revisions for what defines blood pressure and cholesterol goals, there’s been a lot of debate about what to believe. Are drug companies behind this so they can sell more medications? Do doctors benefit in some way by diagnosing more people with high blood pressure and cholesterol based on lower cutoffs? Neither. An interesting article out of JAMA (Journal of the American Medical Association) nicely offers a behind-the-scenes look at how doctors think about risk factors for heart disease.

When doctors see guidelines and new research, they ask 2 questions after seeing the results:

  1. How was the study designed?
  2. How do the results apply to my patients?

As an analogy, let’s say your friends were trying to convince you that pizza helps people live longer. (I wish!) A weak argument might be if they told you that a couple of people they heard lived into their 90s ate pizza every day of their lives. Yea, no thanks. The most convincing argument would be if they took everyone in the world and at random, made them all either eat pizza every day for the rest of their lives or not, and showed that the people who ate pizza every day lived longer than those who didn’t. This last argument would be a simplified version of what’s called a randomized controlled trial: when you test something in one group of people and compare it to another group of people who are essentially the same, but who didn’t get whatever you’re testing. Without getting too much into the weeds about science and statistics, suffice it to say that a lot of the blood pressure and cholesterol guidelines are based on these types of trials. They’re really believable trials. By the way, eating pizza every day will NOT help you live longer… sorry!

So what, right? Well, the article summarizes 7 key risk factors that several trials have shown Americans are terrible at controlling, even though we know they all contribute to heart disease.

  1. Avoiding smoking
  2. Avoiding diabetes
  3. Having a lower total cholesterol (at least less than 200)
  4. Having a lower blood pressure (at least less than 120/80)
  5. Maintaining a normal BMI (body mass index) between 18-25
  6. Exercising at least 150 minutes a week to the point where you break a sweat
  7. Limiting red meats and sugar in the diet and eating more fruit, vegetables, whole grains, dairy, poultry, fish, and nuts

Unfortunately, Americans are bad at avoiding all of these; about 85% have at least one of these risk factors. On top of these, another research study mentioned that regardless of genetics (i.e. what your family oh-so-kindly passed down to you in terms of risk), making good lifestyle changes can substantially reduce your risk of heart disease by about half!

So why can’t we do it? Why is cardiovascular disease still the most common reason people die in this country by a long-shot? Is it because the guidelines keep making it harder? Or is it because our lifestyles are putting us at risk? The guidelines may have recently gotten stricter, but maybe they’re just becoming more honest. Maybe this should be a reality check for us all.

So where should you start? Tell us what you think!

Published by: Mark P. Abrams, MD

I'm an Internist, Educator, and Cardiology fellow in training. As the Director of Patient Engagement at Heartbeat Health, my goal is to make trustworthy information easily accessible and more available so that people can become more active members of their healthcare teams. By joining together, we can work toward keeping more people healthier, happier, and living longer fulfilling lives.

Categories Blood Pressure, Risk FactorsLeave a comment

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