Caring for cardiovascular disease begins with prevention

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability worldwide, but it is largely preventable. The American College of Cardiology (ACC) and the American Heart Association (AHA) recently published the 2019 Guidelines for Primary Prevention of Cardiovascular Disease, which includes healthy eating, exercise, smoking cessation, and control of known risk factors (such as high blood pressure, high blood lipids). Key recommendations such as high blood sugar. In addition, aspirin is not recommended for primary prevention in patients without cardiovascular disease. Experts emphasize that a healthy lifestyle is the cornerstone of cardiovascular disease prevention. Let us work together–

One-third of patients who die from illness are caused by cardiovascular disease, which is a serious threat to human health. Every choice we make has a lasting impact on our cardiovascular health. Recently, the American College of Cardiology (ACC) and the American Heart Association (AHA) released the “2019 Guidelines for Primary Prevention of Cardiovascular Diseases” (hereinafter referred to as the “Guide”) at the ACC’s 68th Annual Scientific Meeting. Cardiovascular disease provides comprehensive and practical advice.

General recommendations for prevention of atherosclerotic cardiovascular disease (ASCVD)

The Guide is a comprehensive guidance document for primary prevention of ASCVD. The Guide places special emphasis on the role of lifestyle interventions and risk assessment in the prevention of ASCVD, and proposes a patient-centered approach to integrated ASCVD prevention that emphasizes teamwork, co-decision with patients, and consideration of various social factors.

“No matter whether it is the development of arterial plaque, heart attack, stroke, heart failure, how the heart contracts, how the blood is pumped into other parts of the body, the key way to prevent cardiovascular disease is to adopt a heart-healthy life. Habits, and throughout life.” Dr. Roger S. Blumenthal, Co-Chair of the ACC/AHA Primary Prevention Guidelines for Cardiovascular Diseases in 2019, and Kenneth Jay Pollin, Professor of Cardiology at Johns Hopkins School of Medicine, said: “More than 80% of cardiovascular Diseases can be prevented by lifestyle changes, but we don’t do well in implementing these strategies and controlling other risk factors.”

He pointed out that the new Guide provides a roadmap for primary prevention of cardiovascular disease to help those who do not have a history of heart disease to maintain heart health and emphasizes the need to identify and address personal or social barriers to implementation, such as costs. Problems, lack of health insurance, healthy food or safe sports venues, life stress, etc.

Risk assessment

According to the Guide, any effort to prevent a first-degree cardiovascular disease (called primary prevention) begins with a comprehensive assessment of the individual’s risk—that is, the likelihood that a blocked arteries will result in a heart attack, stroke, or death. How big is sex. All patients should be open and honest with their health management team to discuss their current health habits and personal risks of cardiovascular disease, and work with the team to determine the best way to prevent cardiovascular disease based on current evidence and personal preferences.

Assess cardiovascular risk

◎ For adults between the ages of 40 and 75, clinicians should routinely evaluate traditional cardiovascular risk factors and use a summary cohort equation (PCE) to calculate 10-year ASCVD risk.

◎ For adults aged 20 to 39, it is reasonable to evaluate the traditional ASCVD risk factors every 4 to 6 years.

◎ For adults at critical risk (5% <10 years ASCVD risk <7.5%) or moderate risk (7.5% ≤ 10 years ASCVD risk <20%), use additional risk enhancement factors to guide preventive interventions ( Decisions such as statin therapy are reasonable.

◎ For moderate-risk adults or specific adults at critical risk, if risk-based preventive intervention decisions (such as statin therapy) remain uncertain, measuring coronary artery calcification scores to guide clinician-patient risk discussions is reasonable.

◎ For adults aged 20 to 39 years and 40 to 59 years with a 10-year ASCVD risk of <7.5%, consider estimating life or 30 years of ASCVD risk.

Risk enhancement factor

◎ Family history of early ASCVD (male <55 years old, female <65 years old).

◎ primary hypercholesterolemia.

◎ Metabolic syndrome: elevated triglyceride, elevated blood pressure, elevated blood glucose, and elevated low-density lipoprotein cholesterol. Three of the above factors can be diagnosed.

◎ Chronic kidney disease: with or without albuminuria, without dialysis or kidney transplantation.

◎ chronic inflammation such as psoriasis, rheumatoid arthritis (RA), lupus and so on.

◎ Premature menopause (before age 40) and a history of pregnancy-related diseases that increase the risk of late ASCVD, such as pre-eclampsia.

◎ Continue to increase primary hypertriglyceridemia.

Key analysis

Blumenthal said: “There is sufficient evidence to demonstrate how to identify these high-risk groups through physical examinations and detailed medical history. For those at critical risk, there are ways to help determine who is at higher risk and should take it as early as possible. Statins and other methods to prevent cardiovascular events." "In the past, many people thought that they will have heart problems sooner or later. In fact, most cardiovascular events can be prevented."

The Guide combines best data and proven interventions such as improving diet and increasing exercise, quitting smoking and controlling other risk factors that can cause heart problems and stroke (such as obesity, diabetes, high cholesterol and high blood pressure). The Guide also discusses factors that may influence people to build good habits.

Lifestyle change advice

The Guide emphasizes that a healthy lifestyle is the cornerstone of heart disease prevention and provides further practical advice based on the latest research.

Blumenthal said: “Whether it is because we want to see our children and grandchildren grow up, or because we want to stay active when we are old, when we want to live longer and healthier lives, it is very important to improve our diet and exercise habits. ""

The main lifestyle recommendations include:

Eat healthier

The Guide reviews specific diet plans such as the Mediterranean diet, sprint diet, and vegetarian diet.

Guideline recommendations

◎ Emphasis on diets containing vegetables, fruits, beans, nuts, whole grains and fish to reduce ASCVD risk factors.

◎ Replacing saturated fat with monounsaturated fat and polyunsaturated fat is beneficial to reduce the risk of ASCVD.

◎ Reduce the intake of cholesterol and sodium, which is beneficial to reduce the risk of ASCVD.

◎ As part of a healthy diet, it is reasonable to minimize the intake of processed meat, refined carbohydrates and sweetened beverages to reduce the risk of ASCVD.