How can I avoid heart disease or stroke?

Date:
August 30, 2021
Source:
European Society of Cardiology
Summary:
As much as 90% of the risk of a heart attack, stroke, or peripheral
arterial disease (PAD) can be explained by smoking, poor eating
habits, lack of physical activity, abdominal obesity, high blood
pressure, raised blood lipid levels, diabetes, psychosocial factors,
or alcohol. These guidelines focus on atherosclerotic cardiovascular
disease (CVD), which affects the arteries. As the inside of the
arteries become clogged up by fatty deposits, they can no longer
supply enough blood to the body. This process is the main cause
of heart attacks, strokes, PAD and sudden death where arteries
become completely blocked. The most important way to prevent
these conditions is to adopt a healthy lifestyle throughout life,
especially not smoking, and to treat risk factors.



FULL STORY ==========================================================================
The European Society of Cardiology (ESC) Guidelines on cardiovascular
disease prevention in clinical practice are published online today in
European Heart Journal.


==========================================================================
As much as 90% of the risk of a heart attack, stroke, or peripheral
arterial disease (PAD) can be explained by smoking, poor eating habits,
lack of physical activity, abdominal obesity, high blood pressure, raised
blood lipid levels, diabetes, psychosocial factors, or alcohol. These guidelines focus on atherosclerotic cardiovascular disease (CVD), which
affects the arteries. As the inside of the arteries become clogged up by
fatty deposits, they can no longer supply enough blood to the body. This process is the main cause of heart attacks, strokes, PAD and sudden
death where arteries become completely blocked. The most important way
to prevent these conditions is to adopt a healthy lifestyle throughout
life, especially not smoking, and to treat risk factors.

Recommendations are provided for healthy adults of all ages, as well as patients with established CVD or diabetes. Identifying who will benefit
most from preventive treatments, such as blood pressure and lipid lowering therapies, is central to prevention efforts and therefore the estimation
of CVD risk is the cornerstone of the guidelines.

Targets for blood lipids, blood pressure, and glycaemic control in
diabetes remain as recommended in recent ESC guidelines on dyslipidaemias, hypertension or diabetes. The current guidelines introduce a stepwise
approach to intensifying preventive treatments, while always taking into consideration potential benefit, other conditions, psychosocial factors
and patient preferences. In healthy people, for example, the stepwise
approach starts with recommendations for everyone: smoking cessation,
adopting a healthy lifestyle, and maintaining a systolic blood pressure
below 160 mmHg. The recommendations are then tailored according to the
10-year risk of CVD (calculated by a health professional using available
risk scores).

"Individualised decisions using risk estimation and a stepwise approach to therapies is more complex than a one-size-fits-all approach, but reflects
the diversity of patients and patient characteristics in everyday clinical practice, and is essential to give the right patient the right treatment,"
said guidelines task force chairperson Professor Frank Visseren of the University Medical Centre Utrecht, the Netherlands.

A new section is devoted to communication of risk in the shared decision
making process. The aims are for individuals to understand their risk,
the anticipated risk reduction with preventive actions, the pros and
cons of intervention, and their own priorities. In healthy people,
the standard approach is to calculate the likelihood of CVD within 10
years. Young people may find estimations of lifetime risk and lifetime
benefit of preventive action more informative, since their 10-year risk
is generally low.



========================================================================== Stopping smoking is potentially the most effective of all preventive
measures, with substantial reductions in heart attacks or death. The
CVD risk in smokers under 50 years of age is five-fold higher than in non-smokers. Quitting must be encouraged in all smokers, and passive
smoking should be avoided where possible. For the first time, the
guidelines explicitly state that smoking cessation is recommended,
and remains beneficial, regardless of weight gain.

While evidence suggests that e-cigarettes may be more effective than
nicotine- replacement therapy for smoking cessation, the long-term effects
on cardiovascular and lung health are unclear and dual use with tobacco cigarettes should be avoided.

Regarding exercise, adults of all ages should strive for at least
150?300 minutes a week of moderate-intensity, or 75?150 minutes a week
of vigorous- intensity, aerobic physical activity, or an equivalent combination. For the first time it is recommended to reduce sedentary time
and engage in at least light activity throughout the day. Also new is to consider wearable activity trackers to increase activity. The guidelines
state: "Most important is to encourage activity that people enjoy and/or
can include in their daily routines, as such activities are more likely
to be sustainable." Regarding nutrition, a healthy diet is recommended
for all individuals to prevent CVD. This should emphasise plant-based
foods including whole grains, fruits, vegetables, pulses, and nuts. New recommendations include the adoption of a Mediterranean or similar diet; restricting alcohol intake to a maximum of 100 g per week (a standard
drink contains 8 to 14 g); eating fish, preferably fatty, at least once
a week; and restricting consumption of meat, particularly processed meat.

In terms of body weight, it is recommended that overweight and obese
people lose weight to lower blood pressure, blood lipids, and the risk of diabetes, and thereby reduce the likelihood of CVD. For the first time,
the guidelines state that bariatric surgery should be considered for
obese individuals at high risk of CVD when a healthy diet and exercise
do not result in maintained weight loss.

Mental disorders such as anxiety are associated with an increased risk
of CVD and a worse prognosis for those already diagnosed with CVD. A
new recommendation is to provide intensified support to patients with
these conditions to improve adherence to lifestyle changes and drug
treatment. Also new is to consider referral to psychotherapeutic stress management for patients with CVD and stress.

The guidelines recommend policy interventions at the population level
to improve heart health and promote healthy choices. These include
measures to lower air pollution, reduce fossil fuel use, and limit
carbon dioxide emissions. Other measures are greater availability of
school playground spaces, and legislation that restricts marketing
unhealthy food to children on television, the internet, social media,
and food packaging. E-cigarettes, which are addictive, should be subject
to similar marketing controls as standard cigarettes, especially flavoured varieties that appeal to children. Labelling alcohol with caloric content
and health warnings may be considered.

As summarised by guidelines task force chairperson Professor
Franc,ois Mach of Geneva University Hospital, Switzerland, "CVD
prevention requires an integrated, interdisciplinary approach that
puts healthy people and patients at the centre and considers other
health conditions, and environmental factors including air pollution." ========================================================================== Story Source: Materials provided by European_Society_of_Cardiology. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Frank L J Visseren, Franc,ois Mach, Yvo M Smulders, David Carballo,
Konstantinos C Koskinas, Maria Ba"ck, Athanase Benetos, Alessandro
Biffi, Jose'-Manuel Boavida, Davide Capodanno, Bernard Cosyns,
Carolyn Crawford, Constantinos H Davos, Ileana Desormais, Emanuele
Di Angelantonio, Oscar H Franco, Sigrun Halvorsen, F D Richard
Hobbs, Monika Hollander, Ewa A Jankowska, Matthias Michal,
Simona Sacco, Naveed Sattar, Lale Tokgozoglu, Serena Tonstad,
Konstantinos P Tsioufis, Ineke van Dis, Isabelle C van Gelder,
Christoph Wanner, Bryan Williams, Guy De Backer, Vera Regitz-
Zagrosek, Anne Hege Aamodt, Magdy Abdelhamid, Victor Aboyans,
Christian Albus, Riccardo Asteggiano, Magnus Ba"ck, Michael A
Borger, Carlos Brotons, Jelena Čelutkienė, Renata Cifkova,
Maja Cikes, Francesco Cosentino, Nikolaos Dagres, Tine De Backer,
Dirk De Bacquer, Victoria Delgado, Hester Den Ruijter, Paul Dendale,
Heinz Drexel, Volkmar Falk, Laurent Fauchier, Brian A Ference,
Jean Ferrie`res, Marc Ferrini, Miles Fisher, Danilo Fliser, Zlatko
Fras, Dan Gaita, Simona Giampaoli, Stephan Gielen, Ian Graham,
Catriona Jennings, Torben Jorgensen, Alexandra Kautzky-Willer,
Maryam Kavousi, Wolfgang Koenig, Aleksandra Konradi, Dipak Kotecha,
Ulf Landmesser, Madalena Lettino, Basil S Lewis, Ales Linhart,
Maja-Lisa Lo/chen, Konstantinos Makrilakis, Giuseppe Mancia, Pedro
Marques-Vidal, John William McEvoy, Paul McGreavy, Bela Merkely,
Lis Neubeck, Jens Cosedis Nielsen, Joep Perk, Steffen E Petersen,
Anna Sonia Petronio, Massimo Piepoli, Nana Goar Pogosova, Eva
Irene Bossano Prescott, Kausik K Ray, Zeljko Reiner, Dimitrios
J Richter, Lars Ryde'n, Evgeny Shlyakhto, Marta Sitges, Miguel
Sousa-Uva, Isabella Sudano, Monica Tiberi, Rhian M Touyz, Andrea
Ungar, W M Monique Verschuren, Olov Wiklund, David Wood, Jose Luis
Zamorano, Yvo M Smulders, David Carballo, Konstantinos C Koskinas,
Maria Ba"ck, Athanase Benetos, Alessandro Biffi, Jose'-Manuel
Boavida, Davide Capodanno, Bernard Cosyns, Carolyn A Crawford,
Constantinos H Davos, Ileana Desormais, Emanuele Di Angelantonio,
Oscar H Franco Duran, Sigrun Halvorsen, F D Richard Hobbs, Monika
Hollander, Ewa A Jankowska, Matthias Michal, Simona Sacco, Naveed
Sattar, Lale Tokgozoglu, Serena Tonstad, Konstantinos P Tsioufis,
Ineke van Dis, Isabelle C van Gelder, Christoph Wanner, Bryan
Williams. 2021 ESC Guidelines on cardiovascular disease prevention
in clinical practice.

European Heart Journal, 2021; DOI: 10.1093/eurheartj/ehab484 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210830095959.htm

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