The New Heart Disease And Stroke Prevention Guidelines
Take care of your heart
Overall heart disease burden
Heart diseases refer to the diseases of the heart and blood vessels, such as coronary artery disease, heart rhythm disorders called arrhythmias and defects of the heart present at birth known as the congenital heart defects.
Approximately 2 out of every 3 people who have heart attacks experience chest pain, shortness of breath or fatigue a few days or weeks before the attack.
Every year, about 720,000 Americans suffer from heart attacks. Of these, 515,000 are a first heart attack and 205,000 happen in people who have already had a heart attack.
The number of noninstitutionalized adults with diagnosed heart disease is 26.6 million.
Such enormous is the heart disease burden that by 2020 heart disease will be the leading cause of morbidity and mortality throughout the world.
Under age 50, women's heart attacks are twice as likely as men's to be fatal. 8 million women in the US are currently living with a heart disease.
28th of September being the World Heart Day, in this hub I would try to sum up the latest guidelines for prevention of heart diseases and stroke, as provided by the American Heart Association.
The new AHA guidelines for prevention of heart diseases focuses on four major aspects, that include -
- Risk assessment
Statin Therapy or HMG Co-A reductase inhibitors
Statins work by blocking the enzyme HMG Co-A reductase, the rate-limiting enzyme in cholesterol synthesis. They reduce cholesterol synthesis in the liver with a compensatory increase in hepatic LDL receptors so that liver can take more of the cholesterol that it needs, from the blood leading to a decrease in circulating LDL cholesterol by up to 35%. These agents are usually given once in the evening as most cholesterol synthesis takes place overnight.
Low cholesterol for a healthy heart
Cholesterol is a steroid hormone essential for normal functioning of our body. It is synthesized by the liver and blood levels more than 200 mg/dl put a person at risk of cholesterol getting deposited in blood vessel walls and increasing the risk of heart diseases. There are two main types of cholesterol - HDL or good cholesterol and LDL or bad cholesterol, along with Triglycerides and VLDL cholesterol.
The new AHA (American Heart Association) guidelines recommend cholesterol-lowering medication HMG Co-A reductase inhibitors or statins for the following groups of individuals -
- People without heart diseases who are 40-75 years old and have a 7.5% or higher risk of having a heart attack or stroke within 10 years.
- People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral arterial disease, Transient ischemic attacks or coronary or arterial revascularization).
- People 21 years or older who have a very high level of bad cholesterol (LDL >190 mg/dl).
- People with type-I or type-II diabetes who are 40-75 years old.
For those already on statin therapy, they no longer get LDL level down to a specific target number, but focus instead on matching a person's risk level with the intensity of statin therapy.
The new guideline also advises doctors not to prescribe additional cholesterol lowering medicines, as for example Niacin and fibrates to patients who reach the target with statins alone.
A healthy lifestyle should accompany statin therapy, that includes a heart-healthy diet, being physically active, not smoking and staying at a healthy weight.
Statins are considered safe drugs despite a small risk of muscle problems and accelerated development of diabetes in people with prediabetes. The AHA guideline recommends the use of statin therapy, despite the side effects due to their life-saving benefit.
Statin therapy leads to lowering of endogenous Coenzyme-Q10 levels in the body. To fulfill the deficit, Coenzyme-Q10 supplements are required.
Stay active to live longer
A healthy lifestyle builds a healthy heart
Do not sweat satisfying a sweet tooth every now and then.
Sticking to an overall heart healthy diet is more important than avoiding or agonizing over the occasional indulgence.
Lifestyle is the beginning of everything to prevent heart diseases. The new AHA guideline recommends increased intake of fruits, vegetables, whole grains, low-fat dairy, poultry, fish and nuts. It puts limits on intake of red meat, sugary food and beverages.
It also recommends heart healthy diets like the Mediterranean diet and DASH diet. Excess intake of salt saturated fat and trans fat is a total No-No.
Current US sodium consumption is around 3600 mg/day. For those to lower blood pressure, it should not be more than 2400 mg/day. A further reduction to 1500 mg/day of sodium is desirable, as it causes a further reduction in blood pressure.
You got to cut out the consumption of processed food that is high in sodium and to cook at home, more often.
In order to lower cholesterol, saturated fat consumption should be less than 5-6% of total calorie intake; for someone consuming 2000 calories per day, it accounts to 13 grams of saturated fat. The main sources of saturated fat include fatty beef, lamb, pork and poultry with skin. Also high in saturated fat are full-fat dairy products like cream, butter, cheese and products with whole or 2% milk.
One also needs to avoid intake of fried and baked foods that are high in trans fats, as for example pastries, pizza dough, cookies and crackers.
Regular physical activity, with at least 40 minutes of aerobic exercises of moderate to vigorous intensity at least 3-4 times every week is desirable. Brisk walking, swimming, bicycling and dancing are good options to stay active.
These lifestyle modifications should be incorporated throughout the therapeutic window.
DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern promoted by the US-based National Heart, Lung and Blood Institute to prevent and control hypertension. The DASH diet is rich in fruits, vegetables, whole grains and low-fat dairy foods; includes meat, fish, poultry, nuts and beans; and is limited in sugar-sweetened foods and beverages, red meat and added fats.
Mediterranean diet is a modern nutritional recommendation originally inspired by the traditional dietary patterns of Greece, Southern Italy and Spain. The main aspects of this diet include proportionately high consumption of olive oil, legumes, unrefined cereals, fruits and vegetables; moderate to high consumption of fish; moderate consumption of dairy products (mostly as cheese and yoghurt); moderate wine consumption and low consumption of meat and meat products.
The new AHA guidelines for preventing heart diseases
- Take statins if you have a history of heart disease, age 40-75 years and a risk of 7.5% or higher, people with diabetes and those with high cholesterol levels.
- Mediterranean and DASH diets with plenty of fruits, veggies, whole grains, legumes and low-fat dairy improve heart health.
- Stay active. At least 40 minutes of aerobic exercise of moderate to vigorous intensity 3-4 times every week makes the heart stronger.
- To avoid obesity, cut down your calorie intake, follow a regular exercise plan and if nothing works, then go for weight loss surgery (BMI >35 with at least one health problem).
- Get your 10-year risk of heart disease calculated using a risk calculator.
Fight the obesity epidemic
Obesity is actually a disease that increases the risk of high blood pressure, type-2 diabetes, stroke and heart diseases.
To reduce the incidence of obesity, the new AHA guidelines advise to cut 500 or more calories per day from the diet, an exercise plan to move at least two and a half hours per week and weight-loss surgery for obese with obesity-related health problems like diabetes, sleep apnea or high blood pressure.
Body Mass Index (BMI) is calculated by dividing body weight in kilograms by the height in meters squared.
Individuals with a Body Mass Index of 30 or higher are considered obese and need treatment; those with a BMI in the range of 25-29 are overweight, and if associated with one risk factor like high blood pressure or increased serum Triglyceride levels, require serious measures to be adopted to lose weight.
For such individuals, the AHA guideline recommends medically supervised weight loss programs that lay focus on the following aspects-
- Eat fewer calories than your body needs.
- Get aerobic exercise for 30 minutes most days of the week.
- Learn the skills to change unhealthy behavior.
Behavioral strategies like regular weight monitoring, setting goals, tracking food and caloric intake and creating an environment at home that discourages overeating, are also helpful in reducing weight.
Regular diet counselling to help overweight people build up their ability to deal with temptations and other challenges is an essential part of weight loss regime.
A regular weight loss routine under the guidance of a registered dietitian, behavioral psychologist or other trained professional in health care settings along with telephone or web-based weight loss programs can be followed.
For this, instead of making rigid dietary choices which include foods that are bland and often unpalatable, the dieticians can use person's food preferences and health to select an appropriate diet for every individual.
You need not overwork yourself to reach an ideal target weight as shedding even a modest number of pounds can have health benefits. Sustained weight loss of only 5% of original weight can cause a significant reduction in blood pressure, blood sugar, and serum lipid levels, and only 3% weight loss lowers the risk of type-II diabetes.
If you are obese, you got to exercise for at least 200 to 300 minutes every week. Participating in weight loss maintenance program at least once per year is helpful to keep the spirits high.
For extremely obese with health risks, if behavioral approaches have failed to show any results, then obesity surgery is the only option that remains.
Bariatric surgery can be considered for people with a BMI >40 or higher; BMI of 35 or higher, with at least 1 obesity-related health problem such as type-II diabetes or sleep apnea. It is not recommended for BMI <35.
So loose the pounds and live a longer and disease free life!
Major factors to prevent heart disease and stroke risk
Heart healthy diet
Cut down on calories
No specific target LDL level
Being physically active
Estimates 10 year risk
Other lifestyle improvements
Surgery for extremely obese
Includes race, gender and age
For a better estimation of the risk of heart diseases, a risk calculator has been devised. It determines the 10-year risk of an individual to suffer from heart attack or stroke.
The risk calculator is beneficial for people in the age group of 40-79 years. It uses specific formula and logarithms to calculate the heart disease risk and takes into account parameters like race, gender, age, Total Cholesterol, HDL cholesterol, Blood pressure, use of blood pressure lowering medications, diabetic status and smoking status of an individual.
This risk calculator tools available on many heart disease prevention websites like www.heart.org.
Heart diseases are associated with various risk factors. The non-modifiable risks include family history, age and gender. To prevent the modifiable risk factors-
- Do not smoke.
- Exercise at least 30 minutes on most days of the week.
- Eat a heart healthy diet.
- Maintain a healthy weight.
- Get enough quality sleep.
- Get regular health screenings for blood pressure check, cholesterol and blood sugar levels.
- Take statins on your doctor's advice. They are life-saving medicines.
If you think that you or someone in your presence is having a heart attack, call 911 immediately. Every minute you delay can result in more damage to the heart muscle.
Having a victim chew aspirin after the ambulance has been called may help reduce the size of the blood clot.