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 healthy diet, 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 glycemic control in diabetes remain as recommended in recent ESC guidelines on dyslipidemias, 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).
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.
New recommendations include the adoption of a Healthy diet for all individuals to prevent CVD. The best diet for preventing heart disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and healthy oils, and restricting of red and processed meats, refined carbohydrates, foods and beverages with added sugar, sodium, and foods with trans fat. People with diets consistent with this dietary pattern had a 31% lower risk of heart disease, a 33% lower risk of diabetes, and a 20% lower risk of stroke. The study found that those who adhered most to healthy eating patterns had a 14% to 21% lower risk of cardiovascular disease when compared with those who adhered leas.
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."
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.
Karimi, H.
Master of clinical Nutrition & Dietetics
Reference
-Visseren F, et al. Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 2021.
