American Heart Association updates heart attack, stroke prevention guidelines
DALLAS, July 16 – To avert a first heart attack or stroke, physicians should routinely assess patients’ general risk of cardiovascular disease beginning at age 20, according to new American Heart Association recommendations published in today’s Circulation: Journal of the American Heart Association.
The “AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update” also recommends that physicians calculate the risk of developing cardiovascular disease in the next 10 years for people age 40 and older or for anyone who has multiple risk factors.
“The imperative to prevent the first episode of coronary disease or stroke remains strong because many first-ever heart attacks or strokes are fatal or disabling,” says Thomas Pearson, M.D., Ph.D., who chaired the consensus panel that worked on the update.
The updated guidelines incorporate new findings and expert opinion that have emerged since the American Heart Association published the recommendations in 1997. They reflect recent data on the degree of risk imposed by specific risk factors and the new efforts to categorize people more specifically according to their number and types of risk factors.
“Risk factor screening” includes having blood pressure, body mass index, waist circumference and pulse recorded at least every two years and cholesterol profile and glucose testing at least every five years beginning at age 20.
“Global risk estimation” combines information from all existing risk factors to determine a person’s percentage risk for developing cardiovascular disease in the next 10 years. Multiple areas of slight risk can be more important than one area of very high risk. This estimation is recommended every five years for people age 40 or older or for anyone with two or more risk factors.
“The challenge for healthcare professionals is to begin comprehensive risk reduction for more patients at an earlier stage of their disease,” says Pearson.
The update integrates recommendations from other clinical guidelines and consensus statements developed over the past five years – for example, the American Diabetes Association recommendation for managing high blood pressure and high cholesterol levels in diabetic patients and the U.S. Preventive Services Task Force recommendations for routine health care examinations. Consolidating these various guidelines means that health care providers and patients can use a single source of information to evaluate individual risk for heart disease and stroke and to obtain the latest information about disease prevention.
The panel carefully reviewed the recommendations in each of these statements or guidelines to ensure the consistency.
Notable updates to the guidelines include:
low-dose aspirin for people who have an increased risk for coronary heart disease; and
blood-thinning drugs to reduce stroke risk in people who have atrial fibrillation – an abnormal heart rhythm that can propel blood clots from the heart toward the brain and increase the risk of stroke.
“The U.S. Preventive Services Task Force has always recommended aspirin for secondary prevention in people who already have heart disease but now recommends low-dose aspirin for primary prevention, as well,” says Pearson. “Aspirin can cause gastrointestinal bleeding and may increase the risk of hemorrhagic stroke (bleeding into the brain). But if a person has a 10-year risk of heart disease that exceeds 10 percent, the benefits of aspirin therapy greatly outweigh the risks.”
Similarly, Pearson says studies have clearly shown that using blood-thinners to prevent clot formation, or treatment to eliminate abnormal heartbeats, substantially reduces the risk of stroke associated with atrial fibrillation.
The panel challenges healthcare providers to make prevention a high priority for all patients.
“Health care providers should be asking about smoking and measuring blood pressure and cholesterol levels,” says Pearson. “The public should be encouraged to ask their physicians and other health care providers about these important issues in disease prevention.”
Other recommendations to prevent heart attack and stroke:
No exposure to tobacco smoke
Blood pressure maintained below 140/90 mm Hg; below 130/85 mm Hg for people with kidney damage or heart failure; or below 130/80 mm Hg for people with diabetes
An overall healthy eating pattern
Cholesterol lowered to appropriate level based on individual risk
At least 30 minutes of moderate-intensity physical activity on most (preferably all) days of the week
Achieve and maintain desirable weight (body mass index 18.5-24.9 kg/m2); and
Normal fasting blood glucose (below 110 mg/dL)
Co-authors are Steven N. Blair, P.E.D.; Stephen R. Daniels, M.D., Ph.D.; Robert H. Eckel, M.D.; Joan M, Fair, R.N., Ph.D.; Stephen P. Fortmann, M.D.; Barry A. Franklin, Ph.D.; Larry B. Goldstein, M.D.; Philip Greenland, M.D.; Scott M. Grundy, M.D., Ph.D.; Yuling Hong, M.D., Ph.D.; Nancy Houston-Miller, R.N.; Ronald M. Lauer, M.D.; Ira S. Ockene, M.D.; Ralph Sacco, M.D.; James F. Sallis Jr., Ph.D.; Sidney C. Smith Jr., M.D.; Neil J. Stone, M.D.; and Kathryn A. Taubert, Ph.D.
To all faculty members: The University of Rochester's budget for the Cardiovascular Health Practioners' Institute is still being finalized. Until it is, please purchase only refundable airline tickets. The University wants to remain certain that it will be able to refund you for any expenses encountered in case of cancellation. We will notify you when the budget is finalized, and any type of airline ticket can be purchased. Thank you for your cooperation.
Good morning,
Just seeking some clarification re; travel. Last year my flight was booked through your travel agent and the ticket was couriered to me. Based on your info on the bulletin board , it seems as if the arrangements will be made differently this year.
Please let me kniow as I have not yet booked a ticket.
Cheers,
Jane
Scott, I figure that by September the water in that Jefferson Park lake will be a bit warmer than last year's. It is your turn now to dive and show that CVHP faculty have a heart. All the best this coming year to you and all who made the Institute possible.
NHLBI Study Finds Brief Counseling By Health Professionals
Just 3 hours of advice and counseling by doctors and other health care professionals over 2 years can boost sedentary adults' physical fitness, according to a new study sponsored by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.
The study compared three types of education and counseling, which differed in intensity. Results showed that doctor advice and behavioral counseling worked better than advice alone in increasing sedentary women's physical fitness. However, the added help had no increased effect on sedentary men's physical fitness.
All three methods worked equally well in significantly increasing women's and men's physical activity.
The 2-year, multi-center study is the first controlled trial to compare several methods of education and counseling by physicians and other health care providers for their long-term effects on physical fitness and activity.
Results of the study, "A Randomized Trial of Physical Activity Counseling in Primary Care for Inactive Adult Patients: Results for the Activity Counseling Trial" (ACT), appear in the August 8, 2001, issue of the Journal of the American Medical Association .
"The study shows that doctors and their medical staff can help their patients, especially women, increase their physical fitness and that such an effort doesn't take much time," said NHLBI Director Dr. Claude Lenfant. "For women, such counseling could make a crucial difference because national surveys show they are less likely to be physically active than men."
Physical inactivity is a major risk factor for heart disease and high blood pressure, and contributes to overweight and obesity. Federal recommendations call for adults to engage in at least 30 minutes of moderate-intensity physical activity, such as brisk walking, on five or more days of the week. But, according to the 1996 Surgeon General's Report, Physical Activity and Health, 26.9 percent of women and 21.4 percent of men age 18 or older engage in no leisure-time physical activity.
"If the ACT results could be translated to the general population, then many more American adults would be physically active, and that would be a major public health gain," said Steve Blair, a researcher at the Cooper Institute for Aerobics Research in Dallas, TX, and the ACT study chair.
ACT was conducted at 11 primary care facilities, which were affiliated with three clinical research centers. The centers were: Stanford University in Palo Alto, CA; The University of Tennessee-Memphis; and the Cooper Institute for Aerobics Research in conjunction with The University of Texas Southwestern Medical Center in Dallas. The ACT coordinating center was Wake Forest University School of Medicine in Winston-Salem, NC.
The study involved 874 men and women, ages 35 to 75, who were inactive at the start of the trial and had no clinical cardiovascular disease. Forty-five percent of participants were women and 55 percent men. About 33 percent were minorities.
About 85 percent of the participants had one or more cardiovascular risk factors in addition to physical inactivity. The most common risk factor was overweight or obesity. About 72 percent of women and 75 percent of men were overweight or obese. Additionally, about 33 percent of participants had high blood pressure; about 20 percent had high blood cholesterol; about 10 percent had diabetes; and about 10 percent smoked cigarettes.
Participants were randomly assigned to one of three groups, which received "advice," "assistance," or "counseling." The first group had 2-4 minutes of advice from the doctor about physical activity and were referred to an on-site health educator for more information, which included educational materials on the topic. The assistance group received the same recommendations, plus behavioral counseling by a health educator, one follow-up telephone contact, a monthly interactive newsletter, and an electronic step-counter and calendar. The counseling group got everything the other two groups got plus regular counseling by telephone from a health educator and weekly classes on behavioral skills to help them adopt and maintain their physical activity.
Over 2 years, the interventions amounted to an average of 3 contacts (or 18 minutes of interaction) for both men and women in the advice group, 22 contacts (or almost 3 hours of interaction) for both men and women in the assistance group, and 44 contacts (or 9 hours of interaction) for women and 38 contacts (or 5.5 hours) for men in the counseling group.
Cardiovascular fitness was measured by oxygen uptake during a maximal treadmill test and physical activity levels by a recall questionnaire.
Researchers assessed changes in physical activity and cardiorespiratory fitness for each group and compared the results. The comparisons were done separately for men and women, because investigators felt they might respond differently to the interventions.
After 2 years, when compared with women in the advice group, women in the counseling group had 80 ml/minute and women in the assistance group had 74 ml/minute higher oxygen uptakes (a measure of fitness)-both equaling about a 5 percent improvement. The interventions worked equally well in their effect on reported physical activity.
"The surprise was that the two more intensive interventions worked equally well," said Dr. Denise Simons-Morton, Leader of the NHLBI Prevention Scientific Research Group and NHLBI Project Officer for ACT. "We had thought it would take the more intensive counseling interventions to boost physical fitness. This is a positive message. With fitness, a little help yields an important improvement."
For men, after 2 years, neither of the more intense interventions produced greater cardiorespiratory fitness or physical activity than physician advice alone.
Finally, all of the interventions resulted in similar gains in women's and men's physical activity: At the start of ACT, only about 1 percent of those who volunteered to participate in the study met Federally recommended levels of 30 minutes of moderate-intensity physical activity on five or more days of the week; at the end of the study, 20 percent had achieved those levels.
To interview Simons-Morton, contact the NHLBI Communications Office at (301) 496-4236. To interview Blair, contact Sarah Tollett at the Cooper Institute Communications Office at (972) 716-7092.
NHLBI has published The Practical Guide: Identification, Evaluation, and Treatment of Overwieght and Obesity in Adults to help health professionals work with their patients to aim for a healthy weight. Based on clinical guidelines from NHLBI's Obesity Education Initiative, the guide features treatment algorithms, counseling tips, reproducible patient tipsheets and other tools. Visit http://www.nhlbi.nih.gov/guidelines/obesity/practgde.htm, or call the NHLBI Health Information Center, 301-592-8573 for copies. (Print copy $5.50; free online access.) Also available are free interactive software programs for Palm handheld devices designed to help the health professional at the point of care, at http://hin.nhlbi.nih.gov/palmapps.htm.
Consumers and health professionals can Aim for a Healthy Weight online at http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm. Features include an interactive menu planner, body mass index calculator, electronic textbook, and tipsheets for physical activity and diet.
Additional information about physical activity and other heart health-related materials is available online at http://www.nhlbi.nih.gov.
Just wanted to say hello to all the 2001 Institute attendees. I am using the information in my notebook and all the wonderful handouts as I write the Year 2 application. This is such a wonderful resource and I am so thankful to have it! I got my pictures back and I will be sending some to you, Scott. Julie Harvill
At this point, we are exploring the issue of internet access at the Institute. Although we did NOT have it last time, we all recognize the extreme value of it for people. So we will make every effort to provide this. Watch here (this thread) for updates!
Every room has a data port, if you have a laptop. In addition, we will have at least 1 computer dedicated to internet access, since each CONFERENCE room also has a data port.