Were you one of several million Americans who woke up with high blood pressure on Monday? The American College of Cardiology and the American Heart Association released new blood pressure guidelines on November 13, 2017. The goal is to enhance awareness about elevated blood pressure and emphasize the importance of managing elevated blood pressure through healthy lifestyle changes and medications with the ultimate goal of reducing the risk of heart disease and stroke (cardiovascular disease).The guidelines have lowered the threshold for the diagnosis of high blood pressure (hypertension) and this change will impact the care of several million Americans.
As men get older, they tend to face many new health problems in a short period of time, says HCMC’s Dr. Bryan Nelson. Dr. Nelson is a family medicine physician at HCMC’s Golden Valley Clinic, as well as the Medical Director for the BeWell Clinic downtown and the St. Anthony Village Clinic. In a Healthy Matters podcast, he discussed the types of issues men face around the time they hit “middle-age” and what can be done to prevent and treat these problems. One such problem he focused on in the podcast was cholesterol.
“Cholesterol is important for our bodies,” says Dr. Nelson. “The problem is our liver doesn’t usually discriminate on what type of cholesterol gets made. And it tends to be either a genetic issue—or sometimes an age issue—where our liver starts making different types of cholesterol.”
The “good” cholesterol is called high-density lipoprotein (HDL), while the “bad” cholesterol is known as low-density lipoprotein (LDL).
“When you get a cholesterol check, oftentimes you also get a level called a triglyceride,” Dr. Nelson explains. “Triglycerides are kind of a marker for how much fat is in your system. So, basically what happens is that your LDL cholesterol plus your triglycerides tend to form atherosclerotic plaques. And atherosclerotic plaques, as time goes on, can break off and cause heart attacks, blockages, memory issues, circulatory problems, and erectile dysfunction.”
So, what can we do about it? “There are medicines—and there are some other things you can do besides medicines—to really help change the balance from the good and bad cholesterol,” says Dr. Nelson.
Most cholesterol medications, called statins, work fairly well. However, according to Dr. Nelson, “they have a tendency to cause muscle aches and you have to watch liver enzymes.” Other types of cholesterol medicines are called resins, and there are some herbal remedies out there as well. Both carry similar risks of side effects, though, and herbal remedies are generally untested. Niacin has also been used in the past, but, according to Dr. Nelson, it is not as good as other treatments that are out there.
To hear the entire podcast from May 31, 2015 go to the podcast on WCCO Radio’s site. Healthy Matters with host Dr. David Hilden airs Sunday mornings at 7:30 a.m. on WCCO Radio 830 AM.
Using niacin to improve cholesterol levels doesn’t reduce heart attack or stroke in high risk patients
We’ve all heard that lowering LDL or “bad” cholesterol levels and raising HDL or “good” cholesterol is good for the heart. When lifestyle changes have not been adequate, most treatment effort in the management of heart disease and stroke risk has focused on lowering the LDL or “bad” cholesterol using a class of drugs called statins. In recent years, the use of niacin – a vitamin B3 – in addition to standard statin therapy has been increasing in the U.S. The main effect of niacin is in raising HDL or “good” cholesterol and this was hoped to result in improving heart attack and stroke prevention beyond what was obtained through the use of statins. But recently reported results from a large study state that the long-term effects of niacin do not lead to better outcomes.
“And in fact, niacin use may even be harmful,” explains Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center, who is referring to a recent study in the New England Journal of Medicine that associated niacin with infections, skin problems, and diabetes complications. “While niacin can increase HDL levels and lower LDLs and triglycerides, these apparently favorable changes in the lipid levels did not reduce heart attack and stroke when high risk patients were followed on niacin over the long-term,” says Dr. Ayenew. “The effect or benefit of niacin on patients without prior vascular disease was not looked at in these studies.”
“In light of this research, high-risk patients with prior heart attack, stroke or diabetes with arterial blockages who are currently taking niacin with their statin should review their treatment plan with their provider.”
Dr. Ayenew also asserts that pursuing a healthy lifestyle is still the most beneficial and safest way to avoid cardiovascular disease. If medications are needed to supplement healthy lifestyles, it does appear that statins are very effective and have a better safety profile compared to vitamin B3 or niacin.
Woubeshet Ayenew practices in HCMC’s Cardiology Clinic located in downtown Minneapolis, as well as HCMC’s Brooklyn Center Clinic. He was the local principal investigator for the AIM-HIGH trial that looked at the impact of niacin on people with vascular disease. The cardiology clinic was recently identified as the number one rated cardiology clinic by patients for “overall provider experience” in Minnesota, according to results published by Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), a tool used by the Centers for Medicare and Medicaid Services to collect patient feedback.
In Nov 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) introduced new guidelines to reduce heart attack and stroke through lifestyle changes and selective use of cholesterol-lowering medications.
The ACC/AHA proposed changes to the guidelines for prescribing cholesterol-lowering medications called statins in accordance with the latest clinical study data available on the use of these drugs to reduce heart attack and strokes, due to the high prevalence of heart attack and stroke associated with high blood cholesterol.
“For years, the LDL or ‘bad’ cholesterol level was the basis for the initiation and follow up of statin therapy,” cardiologist Dr. Woubeshet Ayenew at Hennepin County Medical Center explains. “But the new guidelines de-emphasized the value attached to following the LDL level and instead recommended that the intensity of statin therapy match the risk of stroke and heart attack in an individual. For example, high-intensity cholesterol reduction is now recommended for those who have had prior heart attack or stroke, since the recurrence of such events is highest for those individuals.” Continue reading “Will more Americans benefit from cholesterol-lowering therapy?”→