New York (VINNEWS/Rabbi Yair Hoffman)  Heart disease is still the leading cause of death in the world. One big reason is cholesterol – a waxy substance in the blood that is very similar to plaque on your teeth – but is really plaque in your arteries.

Too much of the wrong kind builds up inside the arteries, slowly narrowing them. Often there are no warning signs at all, until the day there is a heart attack or a strokem r”l.

The American College of Cardiology and the American Heart Association have just put out new rules for doctors on how to handle cholesterol. Here is what is new.

1. Start checking earlier.
In the past, cholesterol testing usually began in middle age. The new guidance says to start sooner, especially for people whose families have a history of heart disease. Children with a rare inherited condition that causes very high cholesterol should be checked as early as age nine.

2. A new one-time blood test.
There is a part of the blood called Lp(a). The amount a person has is mostly set by their genes and stays about the same for life. A high level raises the risk of heart disease – by roughly forty percent at one level, and about double at a higher one. Because it does not change, a person only needs this test once. It used to be ignored. Now it is recommended for everyone.

3. A smarter risk calculator.
Doctors use a calculator to estimate a person’s chance of a heart attack or stroke. The old one looked ten years ahead and started at age forty. The new tool, called PREVENT, looks both ten years and thirty years ahead, starts at age thirty, and adds in blood sugar and kidney health. The old calculator was built from about twenty-six thousand people. The new one was built from 6.6 million.

4. Lower targets.
The goal numbers for “bad” cholesterol (LDL) are now lower. For a healthy person, below 100 is the aim. For someone at medium risk, below 70. For someone at high risk, below 55. Lower is better when it comes to preventing heart attacks, strokes, and heart failure.

5.More ways to treat it.
Statins are still the main medicine. But for people who need more, there are now newer options – including pills and injections – that can be added to bring the numbers down further.

6. In Our Own Power.

One more thing the experts stressed: most heart disease – some eighty to ninety percent – is tied to things a person can change. Eating well, staying active, not smoking, sleeping enough, and keeping a healthy weight are still the foundation. The medicines build on top of that, not instead of it.
The big shift is simple: catch problems earlier, look further into the future, and aim lower. (As always, what any one person should do is a question for their own doctor.)

The Six Mitzvos of Guarding One’s Health

Why does any of this matter to halachic Yidden? Because guarding one’s health is not just common sense – it is a mitzvah. In fact, our Poskim point to as many as six of them.
1. There is the mitzvah of “veNishmartem me’od b’nafshosaichem” (Devarim 4:9) – the mitzvah of protecting our health and well-being.
2. Few have heard of the second mitzvah. The verse later on (Devarim 4:15), “Rak hishamer lecha,” is understood by most Poskim to comprise an actual second mitzvah (see Rav Chaim Kanievsky zt”l, Shaar HaTeshuvos #25) – to take special care.
3. There is a third mitzvah, “V’Chai Bahem – and you shall live by them” (VaYikra 18:5).
4. There is a fourth mitzvah found in the verse in Parshas Ki Saytzei (Devarim 22:2), which discusses the mitzvah of Hashavas Aveidah, returning a lost object, with the words “vahasheivoso lo – and you shall return it to him.” The Gemara in Sanhedrin (73a) includes within these words the obligation of returning “his own life to him as well.” In other words, this verse is the source for the mitzvah of saving someone’s life. This is the general mitzvah the Shulchan Aruch refers to in Orach Chaim 325.
5. “Lo Saamod al dam rayecha” – there is a fifth, a negative mitzvah, of not standing idly by your brother’s blood. This is mentioned in Shulchan Aruch (Choshen Mishpat 426:1) and in the Rambam. It includes yourself, and your spouse and children too, by leaving them without you, chalilah.
6. And finally, there is a sixth mitzvah – “Lo suchal l’hisaleim,” a negative commandment associated with the positive commandment of Hashavas Aveidah, in the verse in Devarim (22:3): “You cannot shut your eyes to it.” This verse comes directly after the mitzvah of Hashavas Aveidah. The Netziv (HeEmek She’eilah) refers to this mitzvah as well.

So in conclusion – Don’t overdo the cholent or the kugels.

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