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By Virginia Haiduc
The American College of Cardiology (ACC) and the American Heart Association (AHC) published in March their latest Guideline on the primary prevention of cardiovascular diseases. The main goal of primary prevention is to reduce the risk of developing heart disease or stroke in healthy people. Published in the Journal of the American College of Cardiology and Circulation, the 2019 report covers nine topics: diet, exercise, heart disease risk badessment, obesity and weight loss, diabetes, blood cholesterol, high blood pressure, cessation smoking and use of aspirin.
What is the focus on the guidelines this year?
The latest ACC / AHA guidelines do not put the focus on drugs, but on a healthy lifestyle focused on a heart-friendly diet, physical exercise and the body's health. no smoking.
If we value our cardiovascular health but still eat fried foods or drink sugary or artificial beverages daily, experts recommend changing our eating habits. A heart-friendly diet includes fruits and vegetables, nuts, whole grains and fish. It does not rely on refined carbohydrates, processed meats, trans fatty acids, or sugary drinks.
"Vegetable and Mediterranean diets, combined with increased consumption of lean fruits, nuts, vegetables, legumes and vegetable or animal protein (preferably fish), with intrinsic fiber soluble and insoluble, have always been badociated at a lower risk of mortality than control diets or standard diets in observational studies, "says the report of 2019. White bread, white pasta and white rice are all considered carbohydrates refined. Processed meats include bacon, ham, salami, hot dogs, chicken nuggets and hamburgers, dried beef and pepperoni. Trans fats are considered the worst. In 2015, the US Food and Drug Administration (FDA) decided to remove artificial trans fatty acids from processed foods because they were no longer "generally recognized as safe". This process is ongoing and, at this time, the compliance date for the withdrawal of these foods has been extended to January 1, 2020.
The new report emphasizes that good nutrition and physical activity are important not only for people in good health, but also for people with diabetes or hypertension.
With respect to physical activity, the recommended goal in the guidelines is "at least 150 minutes of aerobic physical activity of moderate intensity accumulated or 75 minutes a week (or a moderate combination of moderate activity and vigorous) ". If we are caught in a sedentary lifestyle without physical activity, we must start slowly and gradually increase the amount of physical activity. It is important to remember that any physical activity is preferable to no physical activity.
Overweight adults (body mbad index or BMI = 25-29.9 kg / m2) or obese (BMI ≥ 30 kg / m2) have an increased risk of heart disease compared to those with normal BMI, and must follow Specific lifestyle interventions for weight loss: increased physical activity, advice, restricted calorie diet, regular measurements and evaluations of BMI and waist circumference. "Existing clinical guidelines strongly recommend that weight-loss maintenance programs, in person or by telephone, provide for regular contact (at least once a month) with a trained interventionist to help participants practice intense physical activity (200 to 300 minutes a week). ), monitor your weight regularly (at least once a week) and follow a low-calorie diet, "says the report.
The 2019 guidelines strongly recommend smoking for all adults because "smoking is the leading preventable cause of illness, disability, and death in the United States." Smoking, chewing tobacco and exposure to second-hand smoke increase the risk of heart disease and stroke. Electronic nicotine delivery systems (ENDS) or electronic cigarettes are also not considered safe.
What is the risk badessment or risk estimate for atherosclerotic cardiovascular disease (ASCVD)?
To prevent heart disease, doctors periodically evaluate patients' risk factors to identify those at risk for cardiovascular disease. A multidisciplinary team approach is considered a more effective tool for primary prevention, as compared to conventional patient care, when a physician guides the patient. A team may include not only physicians from different specialties, but also nurses, nutritionists, pharmacists and social workers. They all work together to help patients better manage their risk factors.
Physicians can badess ASCVD risk for each of the following age groups: 0 to 19, 20 to 39, 40 to 75, and over 75. The 2013 ASCVD Risk Calculator approved by the American College of Cardiology and the American Heart Association estimates the risk of ASVVD over 10 years for the 40 to 75 age group. The guidelines recommend that all patients discuss the risk badessed with a physician for further badessment and appropriate preventive interventions such as coronary calcium scanning.
Recommendations for treatment with cholesterol-lowering drugs
Cholesterol-lowering drugs or statins are recommended for adults between the ages of 20 and 75 years old who have low-density lipoprotein (LDL) cholesterol or low cholesterol levels above 190 mg / dl with diabetes and multiple Associated risk and adults with an intermediate risk of ASCVD (≥ 7.5%), confirmed by a physician.
Can an aspirin a day still keep the doctor away?
One of the big changes in the guidelines is the change in recommendations for the use of aspirin for primary prevention. In healthy people, studies have shown that the risk of bleeding outweighs the potential benefits of aspirin. Therefore, the new guidelines state: "Low-dose aspirin should NOT be administered routinely for the primary prevention of ASCVD in adults over 70 years of age or in adults of any age at increased risk. bleeding. Low dose aspirin (75-100 mg orally) could be considered for the primary prevention of ASCVD among some adults aged 40 to 70 at higher risk of ASCVD, but not at increased risk of bleeding. "
In conclusion, an aspirin a day can always keep the doctor away, but it is not suitable for everyone.
Virginia Haiduc has a doctorate in medicine and is a member of the American Medical Association.
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