By Virginia Haiduc
The American College of Cardiology (ACC) and the American Heart Association (AHC) released last March Guideline in Primary Prevention of Cardiovascular Diseases. The primary goal of primary prevention is to reduce the risk of developing heart disease or stroke in healthy individuals. Published in the Journal of the American College of Cardiology and Circulation, the 2019 report covers nine topics: diet, exercise, risk assessment of heart disease, obesity and weight loss, diabetes, blood cholesterol, high blood pressure, smoking cessation and use of aspirin.
What is the emphasis of the guidelines this year?
The emphasis of the latest ACC / AHA guidelines is not on medication but on a healthy lifestyle, focusing on a heart-friendly diet, exercise, and no smoking.
If we care about our cardiovascular health, but we are still eating fried foods, or drinking sugary or artificially sweetened drinks daily, experts are recommending a change in our eating habits. A heart-friendly diet is one that includes fruits and vegetables, nuts, whole grains, and fish, and is not based on refined carbohydrates, processed meats, trans fats or sugary drinks.
"Diets based on vegetables and the Mediterranean, together with the increased consumption of fruits, nuts, vegetables, legumes and vegetable or animal proteins (preferably fish), with the inherent soluble and insoluble vegetable fiber, have been consistently associated with lower risk of cause mortality than control or standard diets in observational studies, "says the report of 2019. White bread, white noodles and white rice are all considered refined carbohydrates. Processed meats include bacon, ham, salami, hot dogs, chicken nuggets and fast food hamburgers, dried beef and calabrian. Trans fats are considered the worst. By 2015, the United States Food and Drug Administration (FDA) decided to remove artificial trans fats from processed foods because they were no longer "recognized as safe." This is an ongoing process and currently the compliance date for the removal of these foods has been extended to January 1, 2020.
The new report highlights that good diet and physical activity are significant not only for healthy people but also for those diagnosed with diabetes or high blood pressure.
When it comes to physical activity, the recommended goal of the guidelines is "at least 150 minutes per week of moderate cumulative intensity or 75 minutes per week of vigorous intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity)." If we get caught up in a sedentary lifestyle with no physical activity, we need to start slowly and increase the amount of exercise gradually. It is important to remember that any physical activity is better than no physical activity.
Overweight (Body Mass Index or BMI = 25-29.9 kg / m2) or obese (BMI ≥30 kg / m2) adults are at increased risk of heart disease compared to those with a normal BMI and should follow specific lifestyle interventions in order to lose weight: increased physical activity, counseling, calorie-restricted dieting, regular BMI measurements and assessments, and waist circumference. "Existing clinical guidelines strongly recommend face-to-face or telephone weight-loss maintenance programs that provide regular (at least monthly) contact with a trained intervener to help participants engage in high levels of physical activity (200 300 minutes / week), monitor body weight regularly (at least weekly) and consume a hypocaloric diet, "the report said.
The 2019 guidelines strongly recommend that all adults be evaluated for tobacco use, as "smoking is the primary preventable cause of illness, disability, and death in the United States." Smoking, chewing tobacco and exposure to secondhand smoke increase the risk of heart disease and stroke. Electronic nicotine delivery systems (ENDS) or E-cigarettes are also not considered safe.
What is a Risk Assessment or Atherosclerotic Cardiovascular Disease Risk Assessment (ASCVD)?
In order to prevent heart disease, physicians are periodically evaluating patients' risk factors with the goal of identifying those at risk for cardiovascular disease. A multidisciplinary team approach is considered to be a more efficient tool for primary prevention as compared to standard patient care when a physician guides the patient. A team can include not only physicians of different specialties, but also nurses, nutritionists, pharmacists and social workers. Everyone works together to guide patients to better manage their risk factors.
Doctors can assess the risk of ASCVD for each of the following age groups: 0-19 years, 20-39 years, 40-75 years and over 75 years. The ASCVD 2013 risk calculator, endorsed by the American College of Cardiology and the American Heart Association, estimates the 10-year risk of ASCVD for the age group 40-75 years. The guidelines recommend that all patients discuss their assessed risk with a physician for further evaluation, and tailored preventive interventions such as coronary calcium testing.
Recommendations for therapy with cholesterol-lowering drugs
Cholesterol-lowering drugs or statins are recommended for adults 20-75 years of age with so-called "low-cholesterol" or low-density lipoprotein (LDL) levels above 190 mg / dl, adults 40-75 years of age with diabetes, adults with diabetes and multiple associated risk factors and adults with intermediate risk of ASCVD (≥ 7.5%) confirmed by a physician.
Can one aspirin a day still keep the doctor away?
One of the major changes in the guidelines is the change in recommendations for aspirin use for primary prevention. In healthy people, studies have shown that the risk of bleeding outweighs the potential benefits of aspirin. Therefore, the new guidelines say: "Low-dose aspirin should NOT be routinely administered for the primary prevention of ASCVD among adults over 70 years of age or among adults of any age who are at increased risk of bleeding. Aspirin in low doses (75-100 mg per day, orally) can be considered for primary prevention of ASCVD among selected adults aged 40 to 70 years who are at higher risk for ASCVD, but not with increased risk of bleeding. "
In conclusion, one aspirin per day can still keep the doctor away, but it is not indicated for everyone.
Virginia Haiduc holds a PhD in Medicine (M.D.) and a member of the American Medical Association.