Guidelines for preventing heart disease and stroke
CLEVELAND, OHIO. Physicians at the Cleveland Clinic have summarized the latest American Heart
Association (AHA) guidelines for preventing heart disease and stroke. Highlights are as follows:
- Smoking – Do not smoke and avoid secondhand smoke.
- Diet – Adopt a healthy eating pattern emphasizing fruits and vegetables. Saturated fat intake should be
less than 10% of calories, daily cholesterol intake less than 300 mg, trans-fatty acids should be avoided, and
salt intake should be less than 2400 mg/day.
- Cholesterol levels – Total cholesterol level should be 200 mg/dL (5.2 mmol/L) or less, HDL cholesterol
should be greater than 40 mg/dL (0.9 mmol/L) for men and greater than 50 mg/dL (1.1 mmol/L) for women,
triglyceride level should be below 150 mg/dL (2.36 mmol/L). The recommended maximum level of LDL
cholesterol varies from 160 mg/dL (4.1 mmol/L) for low-risk people to 100 mg/dL (2.56 mmol/L) for people
with diabetes or a 10-year coronary heart disease risk of greater than 20%.
- Exercise – At least 30 minutes of moderate-intensity physical activity (walking 3-4 miles/hour, gardening,
climbing stairs, dancing, moderate to heavy housework).
- Weight – Body mass index between 18.5 and 24.9 kg/m2.
- For people with type 2 diabetes, fasting plasma glucose level should be controlled between 90 mg/dL
(5.0 mmol/L) and 130 mg/dL (7.3 mmol/L). Postprandial (2 hours after a meal) level should be less than 180
mg/dL (10.1 mmol/L) and glycosylated hemoglobin level should be less than 7%.
- Daily aspirin – A daily aspirin (75-160 mg) is recommended for people at high risk for cardiovascular
disease or stroke or with a Framingham 10-year risk of more than 10%.
- Atrial fibrillation – Warfarin (INR=2.0-3.0) is recommended for patients older than 65 years of age or at
high risk for stroke.
- Hormone replacement therapy for women is not recommended.
The researchers provide an excellent table for calculating the 10-year risk of coronary events.
They also provide specific timetables for medical check-ups. Blood pressure, body mass index, waist
circumference and pulse rate (to screen for atrial fibrillation) should be checked every 2 years and fasting
cholesterol and glucose levels should be checked every 5 years.
Seballos, RJ and Gutierrez, J. Strengthening the standards for preventing heart disease and stroke: the recent AHA
guidelines. Cleveland Clinic Journal of Medicine, Vol. 71, May 2004, pp. 426-32