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American Heart Association updates heart attack, stroke prevention guidelines
To avert a first heart attack or stroke, physicians should routinely assess patients' general risk of cardiovascular disease beginning at age 20, according to new American Heart Association recommendations published in today’s Circulation: Journal of the American Heart Association.
The "AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update" also recommends that physicians calculate the risk of developing cardiovascular disease in the next 10 years for people age 40 and older or for anyone who has multiple risk factors.
"The imperative to prevent the first episode of coronary disease or stroke remains strong because many first-ever heart attacks or strokes are fatal or disabling," says Thomas Pearson, M.D., Ph.D., who chaired the consensus panel that worked on the update.
The updated guidelines incorporate new findings and expert opinion that have emerged since the American Heart Association published the recommendations in 1997. They reflect recent data on the degree of risk imposed by specific risk factors and the new efforts to categorize people more specifically according to their number and types of risk factors.
"Risk factor screening" includes having blood pressure, body mass index, waist circumference and pulse recorded at least every two years and cholesterol profile and glucose testing at least every five years beginning at age 20.
"Global risk estimation" combines information from all existing risk factors to determine a person's percentage risk for developing cardiovascular disease in the next 10 years. Multiple areas of slight risk can be more important than one area of very high risk. This estimation is recommended every five years for people age 40 or older or for anyone with two or more risk factors.
The update integrates recommendations from other clinical guidelines and consensus statements developed over the past five years. The panel carefully reviewed the recommendations in each of these statements or guidelines to ensure the consistency.
Notable updates to the guidelines include:
low-dose aspirin for people who have an increased risk for coronary heart disease; and
blood-thinning drugs to reduce stroke risk in people who have atrial fibrillation - an abnormal heart rhythm that can propel blood clots from the heart toward the brain and increase the risk of stroke.
"The U.S. Preventive Services Task Force has always recommended aspirin for secondary prevention in people who already have heart disease but now recommends low-dose aspirin for primary prevention, as well," says Pearson. "Aspirin can cause gastrointestinal bleeding and may increase the risk of hemorrhagic stroke (bleeding into the brain). But if a person has a 10-year risk of heart disease that exceeds 10 percent, the benefits of aspirin therapy greatly outweigh the risks."
Similarly, Pearson says studies have clearly shown that using blood-thinners to prevent clot formation, or treatment to eliminate abnormal heartbeats, substantially reduces the risk of stroke associated with atrial fibrillation.
Other recommendations to prevent heart attack and stroke:
No exposure to tobacco smoke
Blood pressure maintained below 140/90 mm Hg; below 130/85 mm Hg for people with kidney damage or heart failure; or below 130/80 mm Hg for people with diabetes
An overall healthy eating pattern
Cholesterol lowered to appropriate level based on individual risk
At least 30 minutes of moderate-intensity physical activity on most (preferably all) days of the week
Achieve and maintain desirable weight (body mass index 18.5-24.9 kg/m2); and
Normal fasting blood glucose (below 110 mg/dL)
To avert a first heart attack or stroke, physicians should routinely assess patients' general risk of cardiovascular disease beginning at age 20, according to new American Heart Association recommendations published in today’s Circulation: Journal of the American Heart Association.
The "AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update" also recommends that physicians calculate the risk of developing cardiovascular disease in the next 10 years for people age 40 and older or for anyone who has multiple risk factors.
"The imperative to prevent the first episode of coronary disease or stroke remains strong because many first-ever heart attacks or strokes are fatal or disabling," says Thomas Pearson, M.D., Ph.D., who chaired the consensus panel that worked on the update.
The updated guidelines incorporate new findings and expert opinion that have emerged since the American Heart Association published the recommendations in 1997. They reflect recent data on the degree of risk imposed by specific risk factors and the new efforts to categorize people more specifically according to their number and types of risk factors.
"Risk factor screening" includes having blood pressure, body mass index, waist circumference and pulse recorded at least every two years and cholesterol profile and glucose testing at least every five years beginning at age 20.
"Global risk estimation" combines information from all existing risk factors to determine a person's percentage risk for developing cardiovascular disease in the next 10 years. Multiple areas of slight risk can be more important than one area of very high risk. This estimation is recommended every five years for people age 40 or older or for anyone with two or more risk factors.
The update integrates recommendations from other clinical guidelines and consensus statements developed over the past five years. The panel carefully reviewed the recommendations in each of these statements or guidelines to ensure the consistency.
Notable updates to the guidelines include:
low-dose aspirin for people who have an increased risk for coronary heart disease; and
blood-thinning drugs to reduce stroke risk in people who have atrial fibrillation - an abnormal heart rhythm that can propel blood clots from the heart toward the brain and increase the risk of stroke.
"The U.S. Preventive Services Task Force has always recommended aspirin for secondary prevention in people who already have heart disease but now recommends low-dose aspirin for primary prevention, as well," says Pearson. "Aspirin can cause gastrointestinal bleeding and may increase the risk of hemorrhagic stroke (bleeding into the brain). But if a person has a 10-year risk of heart disease that exceeds 10 percent, the benefits of aspirin therapy greatly outweigh the risks."
Similarly, Pearson says studies have clearly shown that using blood-thinners to prevent clot formation, or treatment to eliminate abnormal heartbeats, substantially reduces the risk of stroke associated with atrial fibrillation.
Other recommendations to prevent heart attack and stroke:
No exposure to tobacco smoke
Blood pressure maintained below 140/90 mm Hg; below 130/85 mm Hg for people with kidney damage or heart failure; or below 130/80 mm Hg for people with diabetes
An overall healthy eating pattern
Cholesterol lowered to appropriate level based on individual risk
At least 30 minutes of moderate-intensity physical activity on most (preferably all) days of the week
Achieve and maintain desirable weight (body mass index 18.5-24.9 kg/m2); and
Normal fasting blood glucose (below 110 mg/dL)