New study: Heart attack prevention in young and middle-aged people


A new study published in the Journal of the American College of Cardiology (JACC) suggests we are missing an opportunity to help younger people (those under age 55) avoid heart attacks. While I agree with the premise that we can do better with prevention in this age group, I disagree that the best opportunity is to treat them with statins.

At Diet Doctor, we know taking any medication, especially statins, is a personal decision that should be made between an individual and their healthcare provider. Scientific evidence may support the use of statins in certain situations, but that does not mean they are right for everyone.

At the same time, we have to wonder if the emphasis on LDL cholesterol and statins has detracted attention from other potentially more impactful interventions, such as improving metabolic health.

Read more about our take on cholesterol:

This new study is a prime example of how that might be the case.

Researchers from Duke University Medical Center collected data from over 6,600 patients admitted with a first-time heart attack and determined how many of them were “statin candidates” based on the 2018 cholesterol guidelines compared to the 2013 guidelines.

They concluded that most patients under age 55 were not identified as statin candidates, and the 2018 guidelines identified even fewer than the 2013 guidelines. An accompanying editorial called for more aggressive statin therapy in younger individuals well before a first-time heart attack.

The researchers’ conclusion was all about statins.

Those under age 55 with a heart attack had an average LDL cholesterol of 117 mg/dL; in fact, a third of these patients had an LDL below 100 mg/dL. These levels are hardly numbers of concern, yet the assumption is that if someone had a heart attack, LDL must be to blame.

What else did the data show?

  • 46% had high blood pressure
  • 19% had diabetes
  • 21% had metabolic syndrome
  • 66% had HDL below 40 mg/dL
  • 51% were active smokers
  • 41% were obese, with a BMI of over 30.

Faced with data like this, writing an article about how the patients needed statins shows healthcare’s myopic focus on LDL and drug therapy.

I would interpret the study’s data as showing there is a missed opportunity for prevention as well. But the opportunity is in reversing metabolic syndrome and type 2 diabetes, normalizing blood pressure, maintaining a healthy weight, and, of course, helping people quit smoking.

As we have shown here at Diet Doctor, we don’t need pills for most of that.

Instead, we need to focus on an effective, enjoyable, and sustainable lifestyle. We don’t suggest that low-carb and keto lifestyles are the only effective approaches. But we certainly provide the evidence and success stories to show how it is absolutely a viable choice.

It’s a choice that should be presented as an option to any individual with obesity, metabolic syndrome, hypertension, or type 2 diabetes.

The key idea is to recognize the need to address these metabolic risk factors and attack them head-on with the same fervor that current guidelines suggest for managing cholesterol levels.

That’s why we created our continuing education course for health care practitioners. And that’s why we help interpret scientific results and supply practical information that helps people transform their health and their lives with appropriate lifestyle interventions.

As the study declares, heart attack prevention among those under 55 is indeed a missed opportunity. Let’s just be sure we identify and pursue the best possible interventions to take advantage of that opportunity.

Thanks for reading,
Bret Scher, MD FACC

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