By
American Heart Association News March
17, 2019
Living a healthy lifestyle by
getting plenty of exercise and eating a nutritious diet are the keys to
preventing heart disease, according to new guidelines released Sunday.
The guidelines from
the American Heart Association and the American College of Cardiology were
presented Sunday at an ACC annual meeting and led by a group of the country's
leading doctors and scientists. They put under one umbrella an array of
research-based recommendations for doctors to use in counseling patients.
Heart disease and stroke are the
leading causes of death, responsible for an estimated 17 million deaths every
year worldwide. In the United States, cardiovascular disease is listed as the
underlying cause in 840,678 deaths – about 1 out of every 3, according
to the latest AHA statistics.
"The intent is to pull together
all areas for primary prevention into one single file, a kind of one-stop shop
for prevention," said Donna Arnett, co-chair of the 18-person writing
committee. "One of the unique additions in this guideline is that we approached
it from the patient's perspective.
"For example, if clinicians are
thinking about how to advise a patient on how to eat a healthy diet, they
should consider that there may be cultural factors or economic factors at play.
We encourage fresh fruits and vegetables, but for some patients with food
security issues, they may not always be affordable or accessible," said
Arnett, dean of the University of Kentucky College of Public Health and a
professor in the department of epidemiology. "We want to understand and meet
patients where they are; it's a fundamental focus of this guideline."
The guidelines encourage doctors to
ask their patients plenty of questions to understand the impact that
"social determinants of health" are having on their health.
Social
determinants include numerous societal and environmental
"barriers" – such as access to healthy food, safe places to exercise
and quality care – that affect health and health care. Determinants also can
include factors such as quality of sleep, stress and even cultural or societal
perceptions about body size and image.
The expert panel made sure to
emphasize the social determinants, giving specific examples in the guidelines,
said Dr. Joseph Yeboah, who also was on the writing committee.
"We see it all the time as
health care providers. There are a lot of barriers," said Yeboah, an
associate professor of cardiology at Wake Forest School of Medicine in North
Carolina.
"We all come from different
backgrounds and perceive disease differently," said Yeboah, who was born
and grew up in the west African country of Ghana. "In some cultures,
disease is something that hurts, and if it doesn't then it's not disease.
"When you have high blood
pressure, for example, it doesn't hurt. So, you have to let (patients) know
there are consequences to high blood pressure," he said. "It's up to
health care providers to address that barrier first so that the person will
accept the treatment plan. The treatment plan should start with minimizing salt
intake, exercising, weight loss and, if needed, medications."
For adults older than 40, the
guidelines reiterate recommendations that doctors use
a risk calculator to help estimate a patient's chance of
developing cardiovascular disease within the next 10 years – and that doctors
then have a "client-patient risk discussion" before starting a
patient on medicines.
A few key pieces in the guidelines –
which encompass separate recommendations on cholesterol and high blood
pressure, as well as tackling obesity and diabetes – are new. For instance, the
guidelines recommend doctors:
- Should not prescribe aspirin therapy for prevention
because of the risk of bleeding, except in carefully selected patients.
- Should discuss tobacco use and exposure to secondhand
smoke at each visit, and then help patients build a plan to quit smoking
or reduce exposure to secondhand smoke.
In the area about healthy eating,
experts included recommendations for diets that include more plant-based foods
such as vegetables, fruits, nuts and whole grains, and those that feature fish,
lean vegetable or lean animal proteins. The guidelines also urge doctors to
counsel patients to minimize trans fats, processed meat, refined carbohydrates
and sweetened drinks.
The guidelines point out that adults
who are "habitually high consumers of sugar-sweetened beverages"
could find low-calorie sweeteners a useful replacement strategy on the path to
transitioning to water.
Related to exercise, the
guidelines include
recommendations, based on recent federal government guidelines, that
adults should engage in at least 150 minutes a week of moderate-intensity
physical activity or 75 minutes a week at a vigorous pace.
Yeboah said the emphasis on having
doctors counsel their patients about healthy living shows an important shift.
"We go right to behavioral and lifestyle changes first to minimize
cardiovascular disease risk, before adding medication."
Although the guidelines corral
together many individual areas related to preventing cardiovascular disease,
Arnett said the overarching theme is rather simple.
"Healthy living, with diet and
exercise," she said, "is the primary line of defense in preventing
heart disease."
If you have questions or comments about this story, please
email editor@heart.org.
- Commentary
from nutrition expert Penny Kris-Etherton: What
you need to know about the new prevention guidelines
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https://www.heart.org/en/news/2019/03/17/new-guidelines-healthy-lifestyle-managing-risks-are-key-to-preventing-heart-attack-stroke
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