For my final news review of 2012, here are my game-changers" of the year. I call them game-changers because the health news impacted how I treat my patients.
By Howard LeWine, M.D.
Harvard Medical School
Statin drugs continue to show more benefits than harm.
People that use statin drugs may have a higher rate of diabetes. Whether the statins cause the higher rate is uncertain. But what is certain is that people with heart disease greatly lower their risk of heart attack and stroke by staying on a statin. This good news is also true for people at increased risk of heart disease. It's not just that statins lower cholesterol. They also tone down inflammation in the body. Inflammation is a major driver of fatty build-up in arteries. This is the process that leads to heart attacks and strokes.
Bottom line: Most people at increased risk of heart attack or stroke should take a statin. This is true even if their cholesterol level is in the normal range.
The very old, especially frail elderly, do better with higher blood pressure.
People in their 80s and 90s that take medication for high blood pressure often have side effects. A recent study suggests that aiming for normal blood pressure in these folks actually shortens life and increases disability. Older people tend to have stiffer arteries. And when they stand, their blood pressure can drop. This can lead to falls and fractures. In addition, if blood pressure is too low, reduced flow to the heart and brain can cause heart attack or stroke.
Bottom line: Keep blood pressure drugs to a minimum in the elderly, especially those that are frail.
Metformin gets more confirmation as the drug of choice in people with type 2 diabetes.
The drug lowers blood sugar by 20% on average. When combined with diet and exercise, it can bring sugars into the normal range. It doesnt cause weight gain as most other diabetes drugs do. Metformin actually reduces the risk of heart attack. (Other oral diabetes drugs can increase the risk.) Its not expensive.
Bottom line: Start metformin when a short trial of diet and exercise doesn't bring blood sugars to the target goal.
CPR made simple.
"Hands-only" CPR saves more lives than the traditional kind that includes mouth-to-mouth breathing. Most of us freeze when we witness a cardiac arrest. Even those who have taken CPR classes usually can't recall right away exactly what to do at that moment. In addition, there is the fear of doing it wrong. And many people are uncomfortable putting their mouths on a stranger's mouth.
Bottom line: Here's all you need to know: Put your hands on the middle of the person's chest, push hard and relax. Repeat the push-relax cycle twice a second. Don't stop.
All adults should be tested for HIV at least once.
Although this advice is not new, the United States Preventive Services Task Force has made it a formal recommendation. This means it is very likely to be paid for by all forms of insurance. The HIV test is very accurate. There is excellent treatment available. And people with treated HIV have an average life expectancy close to what they would have if they did not have the virus. Treatment dramatically decreases a person's chance of spreading an infection to a sexual partner.
Bottom line: Testing for HIV should be considered as routine as testing for cholesterol.
Most people with blocked heart arteries can be treated with lifestyle changes and medicine.
Too many people with stable heart disease are going right to the operating room for angioplasty. That procedure opens clogged arteries caused by fatty build-up. During angioplasty, the doctor clears the blockage by inflating a balloon within the artery. This crushes the blockage against the artery wall. Usually a tube called a stent is put in to keep the artery open. But new studies find that people with stable coronary artery disease do just as well with medicines alone. Stable coronary disease means there are no symptoms. Or there is chest pain during exercise or stress, but not at other times.
Bottom line: The most important treatment of stable coronary artery is a program of diet, exercise and medicines to reduce fatty build-up in arteries. Aspirin, a statin and other drugs decrease the risk of heart attacks and reduce symptoms.