healthy body tips

Since many people are alone when they suffer a heart attack, without help,the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.

A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. Tell as many other people as possible about this. It could save their lives!!

A cardiologist says If everyone who gets this mail sends it to 10 people, you can bet that we'll save at least one life.

BE A FRIEND AND PLEASE SEND THIS ARTICLE TO AS MANY FRIENDS ! AS POSSIBLE

1. Diabetes  :  One of the major health risk of sitting is the incidence of the slow killer Diabetes. The accurate source of insulin and the burning of the fatty acids depend on the proper isometric reduction. This isometric contraction stops after prolonged hours of sitting. The constant occurrence of this can lead to extreme glucose and fat content which thus leads to Diabetes. The most horrible is that while our isometric reduction has stopped we keep mulching on junk food which makes the situation even bad.
2. Heart Diseases : Stretched sitting causes the health risk with poor blood flow. Lack of movement, leads to slow heart rate and blood transmission.  Improper blood circulation means less blood supply to the heart and thus, less blood flow to the rest of the body. Low heart rate means that the heart is not pumping accurately, which is goes on for a long time, leads to weak heart and at last heart stroke. Heart attack is one of the major health risk of sitting, and also the major reason for rising humanity rate among IT employees.
3. Back Pain : Back pain is one of the most common problems faced by professions working on computers. This will happens due to cramping of the hip flexors and hamstrings. The hip flexors, extend from upper leg to the hip and the lower back. The steady cramping of this vein can cause harsh back pain and leg pain. The work of these valves is blood flow to a certain direction.
   Now, most of us work with on laptops and computers. If you have noticed most of the time we have our neck bend and our eyes stressed on the screen. This is poor attitude for the body and continues poor posture puts excessive strain on the shoulders, back muscles, neck and hand.

1. Diabetes  :  One of the major health risk of sitting is the incidence of the slow killer Diabetes. The accurate source of insulin and the burning of the fatty acids depend on the proper isometric reduction. This isometric contraction stops after prolonged hours of sitting. The constant occurrence of this can lead to extreme glucose and fat content which thus leads to Diabetes. The most horrible is that while our isometric reduction has stopped we keep mulching on junk food which makes the situation even bad.
2. Heart Diseases : Stretched sitting causes the health risk with poor blood flow. Lack of movement, leads to slow heart rate and blood transmission.  Improper blood circulation means less blood supply to the heart and thus, less blood flow to the rest of the body. Low heart rate means that the heart is not pumping accurately, which is goes on for a long time, leads to weak heart and at last heart stroke. Heart attack is one of the major health risk of sitting, and also the major reason for rising humanity rate among IT employees.
3. Back Pain : Back pain is one of the most common problems faced by professions working on computers. This will happens due to cramping of the hip flexors and hamstrings. The hip flexors, extend from upper leg to the hip and the lower back. The steady cramping of this vein can cause harsh back pain and leg pain. The work of these valves is blood flow to a certain direction.
   Now, most of us work with on laptops and computers. If you have noticed most of the time we have our neck bend and our eyes stressed on the screen. This is poor attitude for the body and continues poor posture puts excessive strain on the shoulders, back muscles, neck and hand.

• Eating plenty of vegetables and fruits.
• Making at least half of your daily grain spending whole grains. These may include whole-grain barley, brown rice, whole-grain corn and oatmeal.
• Eating low-fat dairy foods, like as yogurt, cheese and milk.
• Getting lots of nuts and dry beans, lean meat, fish and poultry without the skin.
• Favoring polyunsaturated and monounsaturated fats via vegetable oils, fish and nuts.
• Avoid saturated and transfats, salt, cholesterol and extra sugars.

You Might Like this : 
Top 20 Facts for living longer
prevention guidelines of heart disease

• Eating plenty of vegetables and fruits.
• Making at least half of your daily grain spending whole grains. These may include whole-grain barley, brown rice, whole-grain corn and oatmeal.
• Eating low-fat dairy foods, like as yogurt, cheese and milk.
• Getting lots of nuts and dry beans, lean meat, fish and poultry without the skin.
• Favoring polyunsaturated and monounsaturated fats via vegetable oils, fish and nuts.
• Avoid saturated and transfats, salt, cholesterol and extra sugars.

You Might Like this : 
Top 20 Facts for living longer
prevention guidelines of heart disease

Good info please read till the end...
Very Very Critical Information please share with your friends and relatives.
Dr.Devi Shetty, Narayana Hrudayalaya
(Heart Specialist) Bangalore
A chat with Dr.Devi Shetty, Narayana Hrudayalaya
(Heart Specialist) Bangalore was arranged by WIPRO for its employees .
The transcript of the chat is given below. Useful for everyone.

Qn: What are the thumb rules for a layman to take care of his heart?
Ans:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week; avoid lifts and avoid sitting for a longtime
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar
Qn: Is eating non-veg food (fish) good for the heart?

Ans: No

Qn: It's still a grave shock to hear that some apparently healthy person
gets a cardiac arrest. How do we understand it in perspective?

Ans: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.
Qn: Are heart diseases hereditary?

Ans: Yes
Qn: What are the ways in which the heart is stressed? What practices do you suggest to de-stress?

Ans: Change your attitude towards life. Do not look for perfection in everything in life.
Qn: Is walking better than jogging or is more intensive exercise required to keep a healthy heart?

Ans: Walking is better than jogging since jogging leads to early fatigue and injury to joints
Qn: Can people with low blood pressure suffer heart diseases?

Ans: Extremely rare
Qn: Does cholesterol accumulates right from an early age
(I'm currently only 22) or do you have to worry about it only after you are above 30 years of age?

Ans: Cholesterol accumulates from childhood.
Qn: How do irregular eating habits affect the heart ?

Ans: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.
Qn: How can I control cholesterol content without using medicines?

Ans: Control diet, walk and eat walnut.
Qn: Can yoga prevent heart ailments?

Ans: Yoga helps. (I add this - Tahajjud is better)
Qn: Which is the best and worst food for the heart?

Ans: Fruits and vegetables are the best and the worst is oil.
Qn: Which oil is better - groundnut, sunflower, olive?

Ans: All oils are bad .
Qn: What is the routine checkup one should go through? Is there any specific test?

Ans: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.
Qn: What are the first aid steps to be taken on a heart attack?
Ans: Help the person into a sleeping position , place an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him to a coronary care unit since the maximum casualty takes place within the first hour.
Qn: How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?

Ans: Extremely difficult without ECG.
Qn: What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious heart problems.

Ans: Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.
Qn: Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?

Ans: Yes.
Qn: Marriages within close relatives can lead to heart problems for the child. Is it true?

Ans : Yes, co-sanguinity leads to congenital abnormalities and you may not have a software engineer as a child
Qn: Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart ? What precautions would you recommend?

Ans : When you are young, nature protects you against all these irregularities. However, as you grow older, respect the biological clock.
Qn: Will taking anti-hypertensive drugs cause some other complications (short / long term)?

Ans : Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.
Qn: Will consuming more coffee/tea lead to heart attacks?
Ans : No.
Qn: Are asthma patients more prone to heart disease?

Ans : No.
Qn: How would you define junk food?

Ans : Fried food like Kentucky , McDonalds , samosas, and even masala dosas.
Qn: You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?

Ans: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease.
Qn: Does consuming bananas help reduce hypertension?

Ans : No.
Qn: Can a person help himself during a heart attack (Because we see a lot of forwarded emails on this)?

Ans : Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary care unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up.
Qn: Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?

Ans : No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.
Qn: Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
Ans : Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.
Qn: Is there a relation between heart problems and blood sugar?

Ans: Yes. A strong relationship since diabetics are more vulnerable to heart attacks than non-diabetics.
Qn: What are the things one needs to take care of after a heart operation?

Ans : Diet, exercise, drugs on time , Control cholesterol, BP, weight.
Qn: Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?

Ans : No.
Qn: What are the modern anti-hypertensive drugs?

Ans : There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugs and go for natural ways of controlling blood pressure by walk, diet to
reduce weight and changing attitudes towards lifestyles.
Qn: Does dispirin or similar headache pills increase the risk of heart attacks?
Ans : No.
Qn: Why is the rate of heart attacks more in men than in women?

Ans : Nature protects women till the age of 45. (Present Global census show that the Percentage of heart disease in women has increased than in men )  Qn: How can one keep the heart in a good condition?

Ans : Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for health checkup s if you are past the age of 30 ( once in six months recommended) ....  
Send it to all your friends....... They might be benefitted.

Follow these easy health tips specific to every stage of aging
By Woman's Day Staff
You're never too young—or too old—to start lowering your heart disease risk. Of course, exercising, eating healthy and reducing stress are key throughout life, but due to physiological changes that happen as we age, certain risk factors do become more of a threat.
In Your 20s

Stub Out a Social Smoking Habit
Smoking is enemy number one when it comes to heart disease, and even just a few cigarettes can do damage: New research from McGill University in Montreal found that smoking just one cigarette a day stiffens your arteries by a whopping 25 percent. Plus, smoking erases the hormonal advantage you have from estrogen, which can leave you vulnerable to a heart attack before menopause, explains Dr. Bonow.

Don't Ignore the Birth Control Factor
Remember that hormonal contraceptives slightly increase the risk of blood clots, so if you've ever had one, make sure to discuss it with your doctor before going on birth control. And if you're currently a smoker, don't take oral contraceptives, because the combo can be especially dangerous, says Sharonne N. Hayes, MD, director of the Women's Heart Clinic at Mayo Clinic in Rochester, Minnesota.

Watch Your Alcohol Intake
Moderate amounts of alcohol can have a beneficial effect on your heart. (By "moderate," we mean one drink a day or about 5 ounces—but many restaurants serve far more than that.) Overdoing it can raise triglycerides, increase blood pressure and lead to weight gain, thanks to all those empty calories.

In Your 30s

Get a Grip on Stress
When you're juggling career and family, it's crucial to find stress management techniques that work. "Untamed stress has a direct negative impact on heart health," says Dr. Stevens. "The constant bombardment of adrenaline raises blood pressure and destabilizes plaque in your arteries, making it likely to cause a clot or heart attack."

Lose the Baby Weight
No, you don't have to fit into your skinny jeans by the time the baby's 6 months old, but do aim to get back to your pre-pregnancy weight within one to two years. "Carrying around extra pounds can lead to high cholesterol, high blood pressure and other heart disease risk factors," Dr. Bonow says. Also remember that it's easier to lose weight in your 30s than in your 40s, when your metabolism slows down.

Stay Social
It's important to stay connected to friends and family for the sake of your mood and heart. Research at the University of Pittsburgh School of Medicine found that high levels of loneliness increase a woman's risk of heart disease by 76 percent. On the flip side, having strong social support can help lower your blood pressure and improve other cardiovascular functions. Set aside time once or twice a week to call friends, or make a monthly dinner date.

In Your 40s

Make Sleep a Priority
Thanks to peri-menopause, fluctuating hormone levels can interfere with a good night's sleep. But not getting at least seven hours of shut-eye regularly can lead to increased blood pressure, low-grade inflammation and higher levels of the stress hormone cortisol, all of which are harmful for your blood vessels and heart, explains Jennifer H. Mieres, MD, a cardiologist at New York University School of Medicine and coauthor of Heart Smart for Black Women and Latinas. Lack of sleep has also been linked to weight gain. So establish good habits: Turn in (and wake up) at the same time every day—even on weekends—and do your best to relax before going to bed, whether it's watching a favorite funny TV show or reading.

Reassess Your Risk Factors
You may discover that your cholesterol, blood pressure and blood sugar levels have changed in this decade, even if you aren't doing anything differently, says Dr. Hayes. In fact, 22 percent of 40-something women have high blood pressure and 50 percent have high cholesterol (a jump from 38 percent of women in their 30s), according to the National Heart, Lung, and Blood Institute. Also, be sure to get your thyroid checked around 45; hypothyroidism (an underactive thyroid gland), which becomes more common as women get older, can negatively affect your cholesterol levels as well as your heart.

Step Up Strength Training
You start to lose muscle mass more rapidly in your 40s, which causes your metabolism to slow down since muscle burns more calories than fat. Unfortunately, this makes it harder to stave off those extra pounds. To help maintain muscle and keep your metabolism going, aim for two 15-minute sessions weekly of lifting weights, using a resistance band or doing other toning exercises.

Carve out Personal Time
"Between the demands of work and family, it becomes even more challenging to find time for yourself in your 40s," says Dr. Mieres. But it's crucial to do so—not only to help ease stress but also to guard against depression, which commonly crops up in this decade and can raise your risk of heart disease. "Find at least 10 minutes of ‘me' time every day to do something—even if it's just chatting on the phone with a friend—that helps you destress and regroup," says Dr. Mieres.

In Your 50s

Move More
Around menopause, you tend to gain extra weight around your belly, which can lead to insulin resistance, inflammation and heart strain. Cardiovascular fitness also starts to decline, particularly if you're not that physically active to begin with. "Unfortunately, at this point, women have to burn more calories to stay at the same weight," Dr. Stevens says. Start taking the stairs instead of the elevator whenever you can, walk faster around the mall, or jog to the mailbox to send letters instead of sticking your hand out the car window as you drive by. Small changes really do add up.

Have an ECG
Silent heart abnormalities become more common in your 50s, and an electrocardiogram (ECG) to check your heart's electrical activity can pick them up, says Dr. Goldberg. Also ask your doctor if you should have a stress test; this is especially important if you're just starting to exercise.

Add Fiber
Besides being good for your cholesterol and blood sugar, pumping up your fiber intake (think whole grains like oatmeal, brown rice and flaxseeds, as well as beans, fruits and veggies) can help prevent constipation, which becomes more of a problem as you get older and your digestive system starts to slow down.

In Your 60s

Get Even More Vigilant About Screenings
After you go through menopause and get older, your blood pressure and cholesterol tend to go up, and blood vessels get stiffer. "Have your blood sugar, blood pressure and cholesterol measured yearly," advises Dr. Goldberg.

Consider Medication
If you have hypertension or high cholesterol, the way you've been managing it before may not be enough. "As you get older, you may need more aggressive therapy," Dr. Bonow says. "High blood pressure that was controlled with one medication may now require three to control it." Talk to your doctor about whether you need to add to or adjust your medications to control your risk factors.

Be Alert to Symptoms
Now is when the first noticeable symptoms of heart disease may appear, so it's important to know what's normal for your body and be on the lookout for worrisome signs like chest discomfort, shortness of breath or changes in exercise tolerance—meaning you suddenly feel winded going up a flight of stairs or feel unusually tired for no apparent reason, says Dr. Mieres. If these appear, see your doctor pronto!

Zul's story from himself..

Hi,
I thought of sharing my recent experience with all of you with the hope that you could gain something from it. Note the symptoms and warning signs that i will be relating. Suspecting that your are getting heart attack and making your way as fast as possible to the hospital, I think, is the key to surviving it.
So here is my story.


It was late Saturday night and I was watching a documentary on Nat. Geo. Everyone had gone to bed hours earlier. My wife had been preparing to leave for her one week trip to Institute Aminuddin Baki at Genting Highland the next morning.


It started with pain around the shoulder region spreading to the arms. My neck felt very uncomfortable. It's something I always get whenever I sit in a weird position for an extended time (in this case I am sitting where the TV is on my right side so I have to turn my head when watching) or I also gets it after hours in front of the computer. So I though, it's because of the way I was sitting that causes it but I had only sat there for about 10 minutes. Earlier, I was sitting comfortable with the TV straight. So I decided I should just go to bed. After all its already about 1:30 in the morning. Normally, lying flat on the bed helps as I have done so many times after sitting for hours in front of a computer.


Just as I was going up the stairs, I started to feel a little dizzy and my stomach feels weird and warm. When I got in the bedroom, the a/c was on and it was quite cool. I lie down on the bed. Minutes later I started to sweat- cold sweat. The sweating was so bad that it started dripping from my head and the back of my ears. My stomach feels like I have eaten too much (I did not really ate a lot that night…it just felt that way). It feels as if it I am having a bad case of indigestion and heartburn. Minutes later I started to feel like I am going to puke.. It's the same feeling when you get a severe headache, sweat and feels like you are going to vomit (but this time no headache)


I got up, went downstairs and grab myself minyak cap limau. I always keep this handy for stomach discomfort or “angin”. The sweating is getting worst and as I sat on the sofa, sweat started to drip on to the floor. There was so much of it that my shirt is all wet so I took it off and put my shirt on the floor where the sweat was dripping.

I drank a glass of warm water and decided to go back to the bedroom. The dizziness is still there. My arms felt numb all the way to my fingers. I thought if I could get some sleep then all of these would go away. So I lie down on the bed. I was so sleepy that in between awake and sleep I could tune to my heart beat. It sounded weird, irregular. At this point my breathing was very heavy. The warm in my stomach feels like its moving up to the chest area.I keep thinking and trying to figure out what was going on. Is it just "angin" or indigestion or is it due to food poisoning.


I got up, went to the toilet and tried to make myself puke but couldn't. So I came back into the bedroom and sits at the edge of the bed.. My face was already very pale, I feel very tired and the sweating was still very bad, dripping on the floor . Still sitting on the edge of the bed and feeling very tired and sleepy, I remember asking my sister in law a year earlier about the symptoms she had when she had a heart attack and it seems all the symptoms are there. I still could not believe that I am having a heart attack.

About half an hour had passed and I am still about 50-50 whether to wake up and inform my wife. Then I thought…if this is really a heart attack, then I could die tonight. I thought of my lovely wife and my kids and finally decided to wake my wife up and inform her what is going on.. She was surprised to see my shirt was all wet and my face very pale and sweat dripping. I told her that the symptom I am having is very much like the one her sister had told me and that we should go to hospital.

It only took us about 15 minutes to make it to the hospital. When we arrived at the emergency ward, I could barely walk. I was so tired and was having difficulty breathing. I was immediately asked to lie down and an ECG was performed. An oxygen tube was placed in my nostril and I can see nurses and hospital assistants running towards me. At this point the pain had spread to the jaw and teeth.

The nurses started to poke my wrist and the back of my hands with needles. A drip was connected to my right arm while at the same time a machine that controls a small bottle of medicine was injected on my left hand. I was asked to place a small tablet of medicine under my tongue.
Half an hour later the sweating stops and it feels a little better. In the meantime, my wife who was still waiting outside was still not informed of what had happened to me. It was 2 hours later that she started to inquire what is happening and she was told that I had suffered a major heart attack.

After completing two bottles of drips, I was then pushed into the ICU. ECG/EKG was performed every half an hour for the rest of the night as well as throughout the next day. When the doctor came in the morning, I was informed that I had suffered a major heart attack.

On the scale of 0 to 10, where 0 means alive and 10 means dead, the doctor asked me where I think I stood. I thought for awhile and said 6.5. He said no and said that it was actually about a 9.5. I was so shocked. The doctor then started to give me a cardio 101 lesson and explained that they had injected me with the strongest clot busting drug in the world when I arrived. Clot buster thins the blood and helped to ensure blood continue to flow but does not really solve the blockage problem.

I suppose the clot buster is almost similar to the chemical we use in our kitchen sink when it gets clogged.

After 4 days in ICU I was confirmed stable and plans were being made to move me for further observation in the general ward. An appointment was made with the heart specialist in Penang GH but I had to queue for about a month before I could even see the doctor and performing an angiogram/angioplasty would then take another couple of months.

I decided I do not want to wait and asked the doctor whether I could be transferred to a private hospital. The doctor was very helpful and recommended a specialist for me at the KPJ hospital in Bandar Perda. He called up the doctor (Dr Safari) and make arrangements to send me there.

When I arrived at about 7pm, Doctor Safari greeted me. He said I was very lucky and that the fast action of going to the hospital saved me. He then scheduled for an angiogram and also an angioplasty immediately the next morning. An angiogram is to see how bad the clot was and where it is. It is also to determine the condition of the other coronary arteries (there are 3 main ones). A balloon angioplasty is to clear the blockage in the artery thus allowing blood to flow again.

The procedure took several hours with only little pain and discomfort. Although the procedure is safer than an open heart surgery, it is still dangerous and could be life threatening. A flexible catheter is injected into the groin artery and then guided all the way up to the heart.. Then a dye was injected and on the x-ray screen you could determine where the blockage was. I still have an 80% blockage (the clot buster I guess managed to clear about 20% which helped to allow blood to flow back into my heart. It did not resolve the problem in whole). Was told that when a blood flow to the heart is blocked, any portion of the heart that did not get enough blood and oxygen would then die off, permanently. This then causes the heart to be weak and disrupt its efficiency. Mine was considered a major because the clog happens in the main artery which could damage a huge portion of the heart below it.

Once the blockage is determined, a small balloon is inflated to push the clogs against the artery walls and a drug coated stent (a sort of wire mesh tube) is placed to ensure the arteries do not collapse again. When the balloon is deflated and removed, the stent stays and overtime would become part of the coronary artery. The stent is treated with some types of drugs to prevent a recurrence of abnormal narrowing due to further clotting of the blood since it is made of metal and it attracts blood platelet to stick to it. I was not able to walk or even move my right leg the first 6 hours after the procedure. I spent another day in the hospital and was released the next day with a month long MC.


So what were the symptoms again?
1. Pain around neck and shoulder region and spreading to the arms(in my case it was the left arm).
2. Feeling of indigestion and/or heartburn. Feel warm in the stomach that slowly moves up to the chest.
3. Pressure, fullness or pain in the center of the chest
4. Sudden weakness, dizziness, fainting, sweating, nausea or shortness of breath


Some people (men) have the classic symptoms of severe pain in the chest (feels like someone is squeezing your heart) but I only felt a little pain when I was already in hospital. The above 4 symptoms however, should be generally true to heart attacks in both men and women.
If you suspect you are getting a heart attack. Go quickly to the hospital. Every second counts.

Test for Protein Called ApoB Better Measure of Heart Attack, Stroke Risk
By Salynn Boyles
WebMD Medical News
Reviewed by Elizabeth Klodas, MD

March 27, 2008 -- People at high risk for heart attacks and strokes may need even more aggressive cholesterol control than is currently recommended, experts now say.

In a joint statement released Thursday by the American Diabetes Association (ADA) and the American College of Cardiology (ACC), the experts concluded that measuring LDL, or bad, cholesterol may no longer be the best measure of heart health in these patients.

The panel found that once LDL cholesterol is lowered to recommended levels in high-risk patients, testing for the protein ApoB may more accurately identify those still at risk for cardiovascular events.

If ApoB levels are high, patients may need more aggressive lifestyle interventions or larger doses of lipid-lowering statin drugs, even if LDL cholesterol levels are within normal range, the panel concluded.

"LDL measurement is still very important," ADA Vice President of Clinical Affairs Sue Kirkman, MD, tells WebMD. "But for high-risk people who are on statin therapy it may not be enough to get LDL down below 100 or even 70."
LDL and ApoB

Achieving an LDL of below 100 milligrams/deciliter is now widely recommended for patients with two or more risk factors for heart disease and for those with diabetes but no other major heart disease risk factors.

Guidelines call for a target LDL at or below 70 for patients with established heart disease or diabetes with additional risk factors for heart disease.

These risk factors include high blood pressure, tobacco use, and family history of heart disease.

While aggressive cholesterol treatment has contributed to reductions in heart attacks and strokes, these events are still common among high-risk patients who reach the target goals, Kirkman says. This could occur if other cholesterol particles that contribute to risk are still elevated.

ApoB is a molecule that is present in all the cholesterol particles that significantly contribute to the development of atherosclerosis (also known as plaque or hardening of the arteries). The hope is that measuring ApoB will help patients and their doctors better gauge actual risk because ApoB will be a more accurate measure of the total number of all artery-clogging particles (not just LDL). There is growing evidence that ApoB levels are a better indicator of heart risk than total cholesterol or LDL.

For this reason, the joint panel recommends a target ApoB level of less than 90 for high-risk patients without established heart disease and less than 80 for the highest-risk patients with heart disease or with diabetes and other cardiovascular risk factors.
Statins and Lifestyle

The report could lead to more aggressive treatment of high-risk patients with lipid-lowering statins, but the panel concluded that more research is needed to confirm the benefits of this approach.

The group also called for public health initiatives aimed at promoting lifestyle changes that reduce cardiovascular risk.

Kirkman says patients and their doctors often focus on drug treatments, forgetting that lifestyle changes can also have a big impact on risk.

"It is important to remember that lifestyle is a big part of this," Kirkman says. "Getting patients to improve their diets, stop smoking, and exercise are all critical. It isn't all about drugs."