Long-Awaited Prevention and Treatment Guidelines for Heart Disease Published

Four new guidelines give primary care physicians direction as they help their patients reduce their risk of developing heart disease. (Image: JAMA, ©AMA)

Four new guidelines give primary care physicians direction as they help their patients reduce their risk of developing heart disease. (Image: JAMA, ©AMA)

Much-anticipated national guidelines for reducing most risk factors associated with cardiovascular disease have finally been released—with one exception. Updated guidelines for addressing hypertension, which had been expected to be available earlier this year, are not yet available.

The released guidelines focus on healthy lifestyles, atherosclerotic cardiovascular risk assessment, blood cholesterol management, and obesity.

The healthy lifestyles and risk assessment guidelines are new. The cholesterol management guideline is the first update since 2004. The obesity guideline is the first update of the original document, published in 1998.

Each guideline was created by expert panels convened by the National Heart, Lung, and Blood Institute, which handed over governance, management, and publication of the guidelines last June to the Obesity Society (for the obesity guideline) and to the American Heart Association and the American College of Cardiology along with the Obesity Society for the others.

Guideline for a Healthy Lifestyle
The healthy lifestyle guideline stresses eating a generally heart-healthy diet and engaging in physical activity as key elements for preventing heart attacks, strokes, and other cardiovascular diseases. The guideline’s recommendation on diet doesn’t endorse any specific eating plan, such as the Mediterranean diet; instead, it calls for primary care physicians to develop heart-healthy dietary plans based on the individual patient’s caloric requirements and personal and cultural food preferences, with additional tweaks to account for other medical conditions, such as diabetes.

The healthy lifestyle guideline also calls for a reduction in salt (sodium) consumption but doesn’t endorse a target level, such as limiting sodium intake to 1500 mg/d as advocated by the American Heart Association and others. Regarding physical activity, the guideline advises moderate or vigorous aerobic exercise, such as brisk walking, for an average of 40 minutes 3 or 4 times a week.

Guideline for Cardiovascular Risk Assessment
Previously, cardiovascular risk assessment focused only on coronary heart disease, but the new guideline includes stroke. This is intended to improve overall cardiovascular risk assessment, particularly for women and blacks, who are at much greater risk for stroke then white men.

The guideline promotes risk assessment methods for atherosclerosis-related risk factors that are easily ascertained by a primary care physician, such as age, cholesterol levels, blood pressure, smoking, and diabetes.

Cholesterol Guideline
The cholesterol guideline emphasized reducing low-density lipoprotein cholesterol (LDL-C), the “bad” cholesterol, but doesn’t set a specific target. Instead, the guideline authors recommended moderate- or high-intensity statin therapy for 4 groups:

• Patients with cardiovascular disease
• Patients with an LDL-C level of 190 mg/dL or higher
• Patients with type 2 diabetes who are between 40 and 75 years of age
• Patients with an estimated 10-year risk of cardiovascular disease of 7.5% or higher who are between 40 and 75 years of age

The 10-year risk threshold is a lower percentage than currently used and could lead to a doubling of statin use in the adult US population, from 15% to about 30%.

Guideline for Addressing Obesity
The obesity guideline recommends weight reduction— with a goal of losing 5% to 10% of one’s body weight within 6 months—through a nonspecific reduced-calorie diet, increased physical activity, and adoption of behavioral strategies introduced by a trained professional, who should meet in person with the patient 2 or 3 times a month for 6 months.

The guideline also said that bariatric surgery may provide significant health benefits for patients with a body mass index (BMI) of 40 or higher or a BMI of 35 or higher along with 2 other cardiovascular risk factors.

What About the Hypertension Guideline?
Not included in the rollout of the 4 guidelines was the hypertension guideline, which hasn’t been updated since 2003 and had been expected to be ready for release this summer. American Heart Association President Mariell Jessup, MD, said at a press conference last week that she wasn’t sure when the hypertension guideline would be published but that like the guidelines released today, it will be based on a similar approach, performed by an expert panel.

Categories: Cardiovascular Disease/Myocardial Infarction, Diet, Exercise, Lipids and Lipid Disorders, Obesity