New Do’s and Don’ts For Protecting the Heart; July ’Consumer Reports on Health’ Cover Story is Concise Guide to Tough Decisions on Heart Health

YONKERS, N.Y. -- Making the right decisions about heart health is a complex task made even harder by the rapidly evolving advice that emerges from medical research. To help consumers make the hard decisions they face in trying to shield their hearts, the independent, unbiased health experts at Consumer Reports on Health (CRH) have reviewed the recent findings and medical evidence behind new recommendations.

For example, an advisory panel recently recommended that the government strengthen its already aggressive cholesterol guidelines, a move that could put millions of Americans on cholesterol-lowering medication and cause those already taking it to boost the dosage or switch to stronger, potentially riskier drugs. The new guidelines make lifestyle changes more essential than ever, since they can minimize the need for high doses or possibly let people avoid medication entirely.

Here are some highlights -- and trusted advice -- from the July issue cover report, “The New Do’s and Don’ts for Protecting your Heart”:

Do’s and Don’ts for the New, Aggressive Recommendations for Lowering Cholesterol

-- Do consider CRP: Research has strengthened the connection between heart disease and C-reactive protein (CRP), a marker of arterial inflammation. CRH’s medical consultants say that knowing your CRP level can help you make the decision about how best to follow the new, aggressive recommendations for lowering cholesterol levels. Medical evidence shows that an elevated CRP pushes people into a higher-risk group that justifies more aggressive cholesterol-cutting therapy. Most people with moderate or high coronary risk should consider getting their CRP levels tested. The CRP test requires a small blood sample and costs less than $50.

Do Get the Right Cholesterol-Cutting Drugs: Virtually all people who need to get their LDL (“bad” cholesterol) down to the lowest level will need medication. Many others will too if lifestyle steps don’t suffice.

-- Don’t let ads mislead you. Conflicting drug-ad campaigns can confuse consumers and possibly produce inappropriate choices.

-- Do start with generic lovastatin in most cases. People who require just a moderate LDL reduction (less than 40 percent) should usually start with lovastatin, which has the longest safety record and lowest cost ($28 to $40 per month) of any statin.

-- Do consider stronger medicine if necessary. Individuals who need larger LDL reductions (40 percent or more) or have very high coronary risk because of factors such as heart disease or diabetes should generally take the more powerful drug atorvastatin (Lipitor). It costs $117 per month, but it has a longer safety record than another statin with comparable efficacy plus a proven ability to reduce both heart-attack risk and total mortality.

-- Don’t overlook the last resorts. If moderate doses of atorvastatin don’t suffice, you could either try the highest dose or switch to combination therapy.

-- Do watch for adverse effects. That’s especially important if you’re taking a statin at a high dose or together with other cholesterol-cutting drugs. Call your doctor immediately if your muscles become achy, tender, or weak, because in rare cases statins harm the muscles, releasing a protein that can fatally damage the kidneys.

Do Get the Right Blood-Pressure Medication: Recent studies have caused some experts to urge that treatment guidelines be revised in favor of newer drugs, but CRH’s medical consultants say that’s premature.

-- Do start with a diuretic in most cases. People with high blood pressure should usually start drug therapy with a diuretic, such as hydrochlorothiazide.

-- Do add another drug if necessary: If the diuretic doesn’t reduce blood pressure enough, a second drug is needed: usually a beta-blocker or ACE inhibitor; although a calcium channel blocker or other medication is sometimes appropriate.

Do Diet and Exercise: It’s more important than ever since it can help people reach the new LDL levels with only moderate drug doses. Some disciplined individuals with a high LDL might get by with non-drug steps alone. Do work out regularly and control your weight. Don’t overlook omega-3s: Those fatty acids—supplied primarily by fatty fish—can reduce heart attack risk. Do consider soy and sterols, which can reduce LDL.

Do manage your emotions: Maintaining good emotional health—by treating depression, curbing anger, relaxing, and even just laughing—may be nearly as important for preventing heart attack and stroke as proper diet and exercise.

CRH provides a table to help people find their LDL treatment plan, based on risk factors from high to low, and summarizes their recommendations based on a government advisory panel’s suggestions and growing medical evidence.

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