Look to Heart Association ideas on risk reduction
Look to Heart Association ideas on risk reduction
In May, the Task Force on Risk Reduction of the American Heart Association (AHA) in Dallas issued guidelines for the prevention of heart disease in at-risk patients.1 Implementing the recommendations entails some work, but will save years and money in the long run.
Risk factors, says the report, fall into two categories: those that cannot be changed and those that can. Factors that cannot be changed include a family history of heart disease, gender (males are more at risk), and increasing age. Factors that can be changed include the use of tobacco, poor eating habits, high blood pressure, and physical inactivity. The Task Force recommends regularly checking for risk factors and encouraging a health lifestyle.
The recommended guidelines are as follows:
• Measure blood pressure at least every 2.5 years.
Initiate drug therapy only if the initial blood pressure reading is greater than 160/100 mm Hg or if it’s greater than or equal to 140/90 mm Hg after three months of lifestyle modification.
• Measure total cholesterol and high-density lipoproteins (HDL) in patients over 20 every five years.
Measure low density lipoprotein (LDL) if total cholesterol is at least 240 mg/dL, if total cholesterol is at least 200 mg/dL and the patient has two or more risk factors for heart disease, or if HDL is less than 35 mg/dL. Total cholesterol should be less than 200 mg/dL, and LDL should be less than 130 mg/dL. Consider drug therapy if a patient’s LDL is at least 160 mg/dL and has two risk factors, if LDL is at least 190 mg/dL, or LDL is at least 220 mg/dL in men under 35 or in premenopausal women.
• Advise patients to adhere to the step one diet, which requires no more than 30% of daily calories to come from fat and no more than 10% of those caloriesto come from saturated fat.
• Recommend 30 minutes of moderate-intensity physical activity three to four times a week.
Encourage incorporating an increased level of activity into daily habits. For example, take the stairs instead of the elevator.
• Focus on waist-to-hip ratio (WHR) and body mass index (BMI) in addition to poundage when counseling about weight management.
For men, a desirable WHR is less than 0.9 the number of inches around the waist is 90% of the circumference of the hips. For middle-aged and elderly women, WHR should be less than 0.8.
Reference
1. Grundy SM, Balady GJ, Criqui MH, et al. Guide to primary prevention of cardiovascular diseases: A statement for healthcare professionals from the Task Force on Risk Reduction. Circulation 1997; 95:2,329-2,331.
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