American Heart Association Updates Heart Attack, Stroke Prevention Guidelines

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 (July 16, 2002).

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.

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"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:

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  • 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.

Source: American Heart Association