Currently browsing posts about: AHA(American Heart Association)

Nov 18 2013

What’s up with the new cholesterol/statin guidelines?

Last week, a Feedback comment from a reader, Judith Rice-Jones, inspired me to try to understand what’s going on with the new heart disease prevention guidelines (I can’t say I’m succeeding very well).

Looking forward to your response to the recent recommendations for more people to take statins. Don’t see anything in the new recommendations about changing lifestyle or diet to reduce risks of stroke or heart attack.

Yes, there are lifestyle recommendations.   But lifestyle changes do not make money for drug companies, and they don’t get press attention.

The American College of Cardiology (ACC) and American Heart Association (AHA) issued four sets of guidelines:

  1. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
  2. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults
  3. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
  4. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk

These organizations say:

AHA and ACC are pleased to announce a series of new cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased body weight in adults. These guidelines are based on rigorous, comprehensive, systematic evidence reviews originally sponsored by the NHLBI. The ACC and AHA collaborated with professional organizations to finalize these AHA/ACC cardiovascular prevention guidelines, and stakeholder organizations were invited to review and endorse the final documents.

So these guidelines are a major big deal.  The New York Times said you need to know three things about them:

  • You don’t need to know your cholesterol number (unless it is very high).
  • You do need to know your risk (for this you need to use the risk calculator and, therefore, to know your LDL and HDL levels and blood pressure).
  • If you are at risk, take a statin (most, at least, are generics).

But wait!

As the New York Times also suggested, the new guidelines have taken many by surprise.

This is an understatement.

Problem #1: Authoritative clinicians say more patients should not be taking statins

This announcement is not a result of a sudden epidemic of heart disease, nor is it based on new data showing the benefits of lower cholesterol. Instead, it is a consequence of simply expanding the definition of who should take the drugs — a decision that will benefit the pharmaceutical industry more than anyone else.

This opinion piece points out that members of the group writing the recommendations have financial ties to drug makers, as do both the AHA and ACC.

The guidelines might make sense, they say, if statins

actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case…as shown in a recent BMJ article co-written by one of us.

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease…80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

Problem #2: The risk calculator greatly overestimates risk

The lead article in today’s Times summarizes studies to be published in The Lancet tomorrow concluding that the risk calculator makes the risks seem greater than they really are.

gPy-ry4SPXk0G-GkICHODoRkn2G50X2w8zUU5-t3FrU

New Picture (1)

It will lead many doctors to prescribe statin drugs to people who do not need to take them (from the standpoint of drug companies, that’s the point).

The calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.

What to do?

  • Best to discuss this one with your doctor.
  • For sure, eat your veggies and be active.
  • If you still smoke cigarettes, stop.
  • Stay tuned for further developments.

Just for fun

Let’s let Brian McFadden (Sunday’s New York Times Week in Review) have the last word for today.

Feb 19 2011

American Heart Association says “I ♥ beef”!

The Beef Board, the USDA-managed checkoff program for marketing beef, proudly announces its new partnership with the American Heart Association (AHA).  The Beef Board gets its money from a compulsory tax on cattle ranchers computed every time they sell an animal.  Evidently, the money is well spent.

The AHA will put its HeartCheck symbol on three cuts of lean beef:

  • Boneless Top Sirloin Petite Roast (select grade)
  • Top Sirloin Filet (select grade)
  • Top Sirloin Kabob (select grade)

A member of the Beef Board says: “”We are extremely thrilled to receive the American Heart Association certification because, for consumers, it represents the independent voice of a trusted health organization.”

I’ll bet they are.

Today’s quiz: How much money is the Beef Board paying the AHA to use its CheckMark logo?

I hope it’s a lot more than what the AHA gets (or used to get) for putting its check mark on sugary cereals.  This was $4,500 per product when I updated Food Politics in 2007.  After all, sugary cereals don’t have any saturated fat or cholesterol so they must be heart healthy, no?

Ah partnerships and alliances.  You have to love them.  How will the Beef Board use the HeartCheck?  With an I ♥ Beef  campaign, of course.  Fat content unspecified.

Feb 2 2010

Oh those Canadians: heart-checking McDonald’s!

Thanks to Dr. Yoni Freedhoff for keeping me current on Canadian food politics. His latest post is about the Canadian Heart and Stroke Foundation’s new program to heart-check fast food meals.  The Foundation hasn’t officially announced the program yet, although you can  find it buried in an obscure questionnaire on its website.  Pizza Hut also mentions its participation in the program on its website.   [Update February 3: Pizza Hut has now announced its participation in the program]

The program is coming soon and here’s Dr. Freedhoff’s political cartoon of what it is likely to look like .  No, this isn’t real.  Dr. Freedhoff’s point is that it could be.

What, you might ask, are the criteria for the heart check?  Let’s just try sodium: 720 mg per serving.   Even the late and not lamented Smart Choices program did better than that (480 mg per serving).

You think Dr. Freedhoff is exaggerating and this is improbable?  Alas, not so.  In Australia a couple of years ago, I took this snapshot at a McDonald’s on the Adelaide beach.

The check marks come from the Heart-Tick program of the National Heart Foundation of Australia.  So Canada is just now catching up.  Canadian readers: can’t you do something about this?  And American Heart Association: clean up your act too!

Addendum: Thanks to Lisa Sutherland for pointing out that what gets heart-checked in Canada is comparatively low in U.S. terms.  She sends McDonald’s nutrition information as proof.   Practically everything is higher in sodium than 720 mg.  When it comes to sodium, everything is relative, I guess, but all of it is way high.

Aug 25 2009

American Heart Association: Eat (a lot!) less sugar.

At last, the American Heart Association (AHA) has done something useful.  It advises eating less sugar.  Americans eat way too much, it says, a whopping 22 teaspoons a day on average.  Let’s work this out.  A teaspoon is 4 grams.  A gram is 4 calories.  So the 275 calories in that default 20-ounce soda you picked up from a vending machine come from nearly 17 teaspoons of sugar – close to the average right there.  If you have trouble maintaining weight, soft drinks are an obvious candidate for “eat less” advice.  Neither the Wall Street Journal (in which I am quoted) nor the New York Times say much about how soft drink manufacturers are reacting to this recommendation, but it isn’t hard to guess.

Here, for example, is what the industry-sponsored American Council on Science and Health (ACSH) has to say:

The study targets added sugars as the main culprit of dietary excess, but since “U.S. labels on packaged foods do not distinguish between naturally occurring or added sugars,” it is difficult to tell the difference. However, “our bodies can’t tell the difference either,” says ACSH’s Jeff Stier. “Natural and added sugars are nutritionally the same. Added sugar causes obesity as much as the orange juice promoted by the American Heart Association causes obesity [e-mail newsletter, August 25, 2009].

Smart Start

This is the first time the AHA has seriously weighed in on sugar.  I find this especially interesting because the AHA has a long history of endorsing sugary cereals (as I discuss in Food Politics and also in What to Eat).  In this example, the AHA’s endorsement is in the lower left corner.  This product has sugars of one kind or another listed 9 times in the ingredient list.

The AHA gets paid for such endorsements.  Let’s hope the new recommendation encourages the AHA to stop doing this.

Update August 27: I really don’t know what to say about the ACSH’s Jeff Stier.  he is acting more like the Center for Consumer Freedom’s Rick Berman every day.   Today’s e-mail newsletter from ACSH contains this statement:

In her blog in The Atlantic, NYU Professor of Nutrition Dr. Marion Nestle has fallen into the habit of suggesting that ACSH is incapable of objective analysis of public health concerns because we are, in her distorted view, “thoroughly industry-sponsored.”

ACSH’s Jeff Stier wrote to her editors: “Like many of the country’s top non-profits, Dr. Nestle’s NYU included, we accept corporate donations, with no strings attached. But we also receive significant support from individuals and foundations. Her misleading description of us suggests that we represent industry. We do not. We are advised by some of the nation’s leading scientists and represent consumers.

“By way of this email, I ask for a conspicuous and fair correction. We are happy to engage on the issues Dr. Nestle writes about, but her attacks on us are below someone of her stature. We’d prefer an informed and enlightening discussion of the issues, not underhanded and unfounded attacks on credibility.”

“Apparently, Dr. Nestle believes that your opinions are irrelevant, since they diverge from her ideological agenda,” says Stier. “We represent you, consumers, who want science rather than ideology informing public health decisionmaking. Does she really think that consumers are so monolithic that they either agree with her or are put up to it by some sinister entity?”

Readers: Does anyone know what is going on with this group?  It sounds so much like the Center for Consumer Freedom that I can’t help but wonder.

Jan 24 2008

Canada’s Health Check program, checkmated

Dr. Yoni Freedhoff, who directs a bariatric medical clinic in Ottawa, sends a video report (in which he stars!) of an investigation into the Canadian Heart and Stroke Foundation’s Health Check program on food labels. This program is much like our American Heart Association’s (AHA) Heart Check program. For both programs, companies pay the organizations for use of the Check on the package label. Both use saturated fat and sodium as cut points for use of the logo, but don’t care much about sugars. I’ve argued for years that putting the AHA’s Check on sugary cereals misleads consumers and is not a good idea. The video–and the press accounts–of this investigation ought to hugely embarrass the organizations, maybe even enough to get them to end the programs.