|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