ACC/AHA guidelines on prevention of cardiovascular disease updated
MedWire News: The American College of Cardiology (ACC) and American Heart Association (AHA) have released updated guidelines on secondary prevention for patients with cardiovascular disease.
A healthy lifestyle and optimal medical therapy can help people who are at high risk for myocardial infarction (MI) and stroke, or those who have already experienced these events, to live longer, improve their quality of life, and lower their risk for another event or revascularization, the guidelines state.
And for the first time, the guidelines recommend the referral of all patients who have experienced MI, stroke, revascularization, or have been diagnosed with angina and/or peripheral artery disease, to a comprehensive cardiac rehabilitation program.
The guidelines are published in the journal Circulation and the Journal of the American College of Cardiology.
They recommend that patients with coronary heart disease and other vascular disease including stroke and peripheral artery disease, stop smoking, participate in at least 30 minutes of exercise 5-7 days a week, and lose weight if overweight, obese, or have a large waist (≥89 cm in women, ≥102 cm in men). These patients are also recommended to receive an annual flu vaccine, and to take low-dose aspirin daily (75-162 mg), unless prescribed a higher dose.
The ACC and AHA have also incorporated evidence from recent clinical trials in recommendations to health practitioners regarding the administration of antiplatelet agents and anticoagulants.
They recommend the use of newer agents including prasugrel and ticagrelor instead of clopidogrel for patients who have been implanted with a drug-eluting or bare-metal stent during percutaneous coronary intervention.
In addition, the guidelines emphasize the importance of adequate dosage for statin therapy on top of therapeutic lifestyle changes for patients with known atherosclerotic vascular disease.
Screening for depression is encouraged in all patients who have recently undergone coronary artery bypass graft surgery or myocardial infarction.
However, recommendations on high blood pressure and high cholesterol have been deferred in anticipation of guidelines that will be released by the National Heart, Lung and Blood Institute in 2012, the writing group states.
Chair of the group, Sidney Smith (University of North Carolina, Chapel Hill, USA), commented in a press statement: "Unless improvements are made in your behavior and medical therapy, the same blood vessel problem that caused your first heart attack or stroke can occur again - and may result in death - so long-term changes need to be initiated to get the vascular disease under control."
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By Piriya Mahendra