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image Cardiologist Robert Garr talks about new guidelines released by the American College of Cardiology regarding relaxed medical intervention of when to prescribe medication for cholesterol and high blood pressure.

February 25, 2014
Heart health guidelines stress diet, exercise over medication

Borderline hypertension or slightly high cholesterol? There’s a pill for that — but your doctor may not prescribe it.

The American College of Cardiology, in conjunction with the American Heart Association, has released new guidelines to doctors regarding when to prescribe medication to manage cholesterol and hypertension, or high blood pressure.

But in both cases, the recommended level of medical intervention has relaxed, according to local cardiologist Robert Garr, D.O. with Oquirrh Cardiology.

The new recommendations advise doctors to refrain from prescribing medication for hypertension in patients older than 60 unless their systolic reading —  the top number on your blood pressure reading, which represents the pressure in the arteries when the heart muscle is contracted — exceeds 150. All others should receive medication when their systolic reading exceeds 140, according to the new recommendations.

Previously, doctors were advised to prescribe blood pressure medication for patients with a systolic reading in excess of 140.

The change was likely intended to reduce the number of medications older Americans are prescribed, Garr said. Each additional prescription increased the risk that the patient might face medication-related complications. And the change makes sense according to current scientific understanding of how people age, he added — as most people age, the arteries tend to stiffen, which gradually and naturally increases blood pressure.

Nonetheless, Garr said it was the first time since he left medical school nearly 20 years ago that he has seen revisions to the recommended treatment for hypertension.

A second set of revisions, also released at the end of 2013, altered the recommended course of treatment for high levels of cholesterol. In general, the new recommendations discourage prescribing medications to lower cholesterol, Garr said, but four groups of people should continue to receive prescriptions: those with coronary artery disease or diabetes, those whose level of “bad” or LDL cholesterol exceeds 190, and those whose risk of having a heart attack in the next 10 years is considered exceptionally high.

A formula that takes family history, blood pressure, cholesterol and some diseases into account can estimate a patient’s 10-year risk, Garr explained.

For at-risk groups, statins are the only group of drugs that continue to be recommended for treatment. Though effective at decreasing concentrations of LDL cholesterol, Garr said scientific study found that statins were the only medications that effectively reduced the risk of heart attack.

The new recommendations should not prompt anyone to go off their current medication unless they are instructed to do so by a physician, Garr cautioned. Rather, he said the revisions represent the medical community’s intent to move toward prescribing lifestyle changes in place of prescription drugs.

“They don’t want people to rely on just taking a pill and thinking that they are saving themselves from a heart attack,” he said.

Healthy diet and regular exercise remain key to preventing a heart attack, Garr said. In particular, residents should avoid excess salt in their diets, and should strive for at least 30 minutes of physical activity every day. For most people, he said, losing just 10 pounds would decrease their odds of a heart attack by 5 to 10 percent.

Smoking is also a considerable risk factor, he said.

Garr, who has worked in Tooele County for nearly seven years, said he has noticed that residents do seem to have disproportionately high rates of hypertension and high cholesterol.

However, he cited recent statistics from Utah’s Indicator-Based Information System for Public Health, which show that Tooele County’s obesity rates have decreased in recent years, as proof that the community is headed in the right direction where health is concerned.

For locals who would like to determine whether they are at risk of a heart attack, Garr sponsors free heart health screenings once a month at his clinic. The next upcoming screening will take place this Friday. Interested individuals should call 435-843-3643 to make an appointment. Oquirrh Cardiology is located next to Mountain West Medical Center at 196 E. 2000 North #10, Tooele.

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