The next time you see your primary care doctor, he or she will have access to updated guidelines and a new electronic tool that can better predict your chances of developing cardiovascular disease, including heart attack and stroke.

The guidelines -- released today from the American College of Cardiology and the American Heart Association -- were developed by a work group co-chaired by Donald M. Lloyd-Jones, M.D., senior associate dean, chair and professor of preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital.

Past guidelines, which were last updated in 2004, only included data from Caucasians and focused on predicting one’s short-term (10-year) risk for coronary heart disease events such as a heart attack. Stroke risk was not a factor in the past guidelines. The new guidelines are based on a broader population sample, including African-Americans, and include stroke risk and both short-term and lifetime cardiovascular disease risk.

“We were tending to under treat women and African-Americans during important years in theirs 40s, 50s and 60s, because we weren’t fully capturing their risk,” Lloyd-Jones said. “We are now smarter about identifying risk and treating more people who will benefit.” The new recommended electronic assessment tool, which calculates a patient’s “cardiovascular risk score,” can be integrated into electronic health records or downloaded on a spreadsheet. The tool uses formulas to calculate a score based on factors such as age, race, gender, blood pressure, smoking, diabetes and cholesterol. The tool displays a percentage and a graphic that shows a patient’s individualized 10-year and lifetime risk versus someone his or her age with optimal risk levels.

The group charged with making these new recommendations also looked closely at existing literature on promising new technologies in the field of cardiology, which include CT scans and urine and blood tests to detect possible heart conditions. While the group does not support using these new risk measures routinely, if a doctor and patient are on the fence about treatment after the risk score has been calculated, there are four measures that show the most helpful assessment potential:

• Family history of premature cardiovascular disease in first-degree relatives (before age 55 in your father or 65 in your mother)
• Coronary artery calcium score, which can show the presence of plaque in artery walls
• High-sensitivity C-reactive protein levels (higher levels have been associated with heart attack and stroke)
• Ankle brachial index, the ratio of the blood pressure in the ankle compared to blood pressure in the arm

“These measure are reasonable for some situations, but we are not recommending them for routine assessment, and they should only be used after the risk equation exercise has been performed,” Lloyd-Jones said.

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Source: Northwestern University News

According to a new study, vitamin D supplements may not reduce heart risks in older women as previously suggested. At total of 305 healthy postmenopausal women aged 60-70 yr were recruited and received a daily capsule of 400 or 1000 IU vitamin D3 or placebo.  Investigators found that the supplements did not have much of an impact on cholesterol, blood pressure and blood sugar.

Source:  Wood et.al.  J of Cl Endo & Metabolism, Aug 3, 2012.

 Consuming a low carbohydrate-high protein diet -- like the Atkins diet -- may be associated with a greater risk of cardiovascular disease in women.   Decreases in carbohydrate intake and increases in protein intake  were all associated with significantly greater risks of incident cardiovascular disease events in young Swedish women, according to Pagona Lagiou, MD, PhD, of the University of Athens in Greece, and colleagues.

The findings, which were reported online in BMJ, "do not answer questions concerning possible beneficial short-term effects of low carbohydrate or high protein diets in the control of body weight or insulin resistance," the authors wrote.   "Instead, they draw attention to the potential for considerable adverse effects on cardiovascular health of these diets when they are used on a regular basis," they wrote.

Low carb-high protein diets have become popular because of the short-term effects on weight control, but concerns have been raised about the potential cardiovascular effects over the long term. Studies exploring the issue have given mixed results, with a U.S. study showing no relationship between such a diet and rates of ischemic heart disease.   But three European studies showed a greater risk of cardiovascular mortality with such a diet.

The current analysis included 43,396 women, ages 30 to 49 at baseline, who completed a comprehensive questionnaire on lifestyle and dietary factors, as well as medical history. They were followed for an average of 15.7 years.   During follow-up, there were 1,270 incident cardiovascular events, which included ischemic heart disease, ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, and peripheral arterial disease.

After adjustment for energy intake, saturated and unsaturated fat intake, and numerous cardiovascular risk factors, each one-point decrease in carb intake was associated with a relative 4% increase in cardiovascular events (95% CI 0% to 8%). There was a suggestion that the associations were stronger for women whose protein came mostly from animal sources, but the test for interaction did not reach statistical significance for nearly all of the individual outcomes.

"Although these results are based on an observational study, their biological plausibility seems self evident," according to Anna Floegel, MPH, of the German Institute of Human Nutrition Potsdam-Rehbruecke, and Tobias Pischon, MD, MPH, of the Max Delbrück Center for Molecular Medicine Berlin-Buch.

"A low carbohydrate diet implies low consumption of whole-grain foods, fruits, and starchy vegetables and consequently reduced intake of fiber, vitamins, and minerals. A high protein diet may indicate higher intake of red and processed meat and thus higher intake of iron, cholesterol, and saturated fat," they explained in an accompanying editorial.

"These single factors have previously been linked to a higher risk of major chronic diseases, including cardiovascular disease, in observational studies, so it is not surprising that this combination of risk factors is linked to a higher incidence of disease and mortality," they said.

For more informations about preventing heart disease, visit:   2011 Guidelines for CVD Prevention in Women

Primary source: BMJ
Lagiou P, et al "Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study" BMJ 2012; DOI:10.1136/bmj.e4026.

Ireland, a land of "happy wars and sad love songs," is also a nation that  is adopting some of the bad eating habits found in the U.S.  and is trying to break those habits.

That assessment comes from Ian Graham, MD, of Dublin's Trinity College, who chairs the Irish Heart Foundation Cardiovascular Prevention Council and is co-chair of the program committee at EuroPRevent 2012, which opened with "Ireland Day," a series of presentations focusing on efforts to tame cardiovascular disease among the Irish.

To illustrate his point, he introduced Robbie Walsh, a 39-year-old Dublin postman who had an MI at age 37.    Walsh, a ruddy-faced man who seemed pleased to share his story with a room full of journalists, said he regularly walked 5 to 6 hours a day delivering mail so he had always considered himself healthy.   But Walsh also smoked about 25 cigarettes a day, "more on the weekends or if I went out for drink," regularly ate red meat, and limited vegetables to "about once or twice a week." And both his father and his brother had heart disease.

Following coronary artery bypass graft surgery for single vessel disease, Walsh entered a standard 12-week long cardio-rehab program that taught him the value of fruits, vegetables, and a life without cigarettes.   Perhaps most importantly, Walsh said, is that he knows that preventing a second heart attack is a lifelong job for him.

Graham, who pointed to Walsh as a success story, said expanding prevention efforts in Ireland, as well as the whole of the European Union and North America, will depend largely upon the buy-in from the primary care community, since all of primary prevention and much of secondary prevention is a "GP job."