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Q-and-A: 7 Questions for Dr. Blaha

Dr. Michael Blaha Dr. Michael Blaha, M.D., M.P.H. is Director of Clinical Research at the Ciccarone Center for the Prevention of Heart Disease

Dr. Michael Blaha explains the new prevention guidelines

Q: How were the latest American Heart Association/American College of Cardiology guidelines developed?

A: It was a rigorous scientific process, probably the most rigorous guidelines ever written for preventing cardiovascular disease. Doctors, nurses and researchers—all members (but not employees) of the American Heart Association and the American College of Cardiology—read hundreds of existing studies. To be included in the final report, the science had to be done correctly, use high-quality data and give evidence-based advice.

Q: What's the purpose of the guidelines?

A: The guidelines were published to give doctors better ways to assess your risk and work with you to stay healthy. They are less about easy bullet points and more about looking at your whole picture—age, health, diet, exercise and other factors such as smoking and cholesterol.

Q: So the guidelines are really for doctors, not patients?

A: Both groups can take home a lot from this work. For patients, the new guidelines are more holistic; they look at the bigger picture, so you're not just focusing on a single behavior like cutting out fat.

But the trouble with advice for consumers is that it has to be general. That's why these new guidelines are geared toward health practitioners. We now have a set of tools to assess risk for each person, and that helps us customize a plan for our patients. 

Q: What's new or different about these guidelines?

A: The guidelines now help doctors evaluate your risk of stroke as well as heart disease. And they account for the difference in risk between Caucasians and African-Americans.

Also, the conversation about diet is better developed. Instead of just advising people to lower their total fat intake, the guidelines discuss lowering sugars and processed foods and increasing fiber, fruits and vegetables. They also recommend adding more whole grains and healthy fats, such as olive oil and nuts, and eating lean proteins, with less red meat and more fish.

Q: What are the basics of the guidelines for consumers?

A: There are actually six different guidelines, and your doctor will help you tailor them to your situation.

  • Learn your risk. Your doctor will discuss this from multiple angles, including your race and gender. You can get a good estimate of your risk of a heart attack or stroke over the next decade and over the next 30 years.
  • Maintain a healthy weight. Your body mass index (BMI) should be normal (below 25) and certainly not obese (over 30). The guidelines give good, practical suggestions on how to improve your BMI.
  • Get your cholesterol numbers in line. Aim for a higher HDL and low total cholesterol.
  • Eat vegetables and fruits, whole grains, lean protein and healthy fats like olive oil and nuts. Avoid most saturated fat, simple sugars and processed foods.
  • Exercise regularly. Talk to your doctor about how much aerobic and strength-training activity you need each week.
  • Don't smoke. If you currently smoke, ask your doctor about how to stop.

Q: Aren't the guidelines controversial?

A: There's a lot of discussion around the role of fats in our diet. Some people think carbs, not saturated fats, are the enemy. In fact, we are still learning about the way we process some foods. But the best science we have today still says the more fruits, vegetables and fiber you eat, the lower your risk of heart attack and stroke.

Second, the new risk calculator may overestimate your true risk of heart attack and stroke over the next decade. Ongoing research on the cost-effectiveness of coronary calcium scans and cardiac CT scans, as well as the use of blood tests for biomarkers other than cholesterol, will be very informative.

Q: Are the new guidelines really an improvement?

A: These are a significant improvement over prior guidelines, because they target better lifestyle habits, the cornerstone of prevention. Selective use of medication may also significantly decrease your risk of a major cardiovascular event.