Guide to Primary Prevention of Cardiovascular Diseases
A Statement for Healthcare Professionals From the Task Force on Risk Reduction
The clinical and public health approaches to primary prevention are complementary. Primary prevention refers to guidance given to persons with no known cardiovascular disease. Physicians can contribute to the public health approach through patient education. The first goal of prevention is to prevent the development of risk factors. Physicians should instruct all patients about adopting healthy life habits that will prevent intensification of risk factors. Patient education should be family oriented. Ideally, risk factor prevention begins in childhood. Preventing cigarette smoking by children and adolescents is a prime goal. Another major goal is prevention of overweight and obesity in children and weight gain in adults; overweight lies at the heart of several risk factors. Encouraging life habits that incorporate regular physical activity, especially walking, and active recreational sports likewise will decrease intensity of risk factors. Patients and their families should be encouraged to reduce their intake of cholesterol and saturated fats by using unsaturated vegetable oils instead of animal-based saturated fats and adopting the habit of eating smaller portions. Evaluation of the family history may reveal that other family members need intervention to avoid developing cardiovascular disease. Adoption of healthy life habits and early intervention will mitigate the severity of risk factors that are the result of aging and genetic factors.
In addition to complementing public health efforts, a clinical approach is needed to detect the presence of established risk factors and to effectively modify them. The physician should regularly check for established risk factors: smoking, physical inactivity, elevated lipid levels, and high blood pressure. In the case of the latter two, the physician should seek the causes (ie, diet and lack of exercise). The recommendations presented in the chart are consistent with the American Heart Association position on risk factor control1 2 3 and the 27th Bethesda Conference, “Matching the Intensity of Risk Factor Management With the Hazard for Coronary Disease Events.”4 These recommendations are also in accord with the recommendations of the Fifth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure5 and the National Cholesterol Education Program (NCEP).6 The AHA, the Joint National Committee, and the NCEP recommend testing for risk factors, beginning in early adulthood. The NCEP has identified low-density lipoprotein cholesterol as the primary target for cholesterol modification. The AHA Task Force on Risk Reduction further recognizes low levels of high-density lipoprotein cholesterol and high levels of triglycerides as secondary targets for lipid modification.
Successful implementation of these recommendations entails a multistep process including assessment, intervention, planning for change, and long-term maintenance and follow-up. These steps can be carried out directly by primary care physicians or through referrals to consultants or specialized programs. Implementation usually requires a team approach involving physicians and other healthcare professionals, including registered dietitians. The physician must commit the time to make a proper assessment and initiate preventive efforts. Patients should be involved in developing an effective plan for change and strategies for altering behavior. A long-term physician-patient relationship is usually needed for successful prevention and modification of risk factors. Physicians must establish office practices consistent with sound prevention strategies.
Introduction of healthy life habits should be universal. These habits include avoidance or cessation of smoking, healthy eating, weight control, and appropriate exercise. The decision to use drug therapy to control risk factors depends on a balanced assessment of absolute risk and the efficacy, safety, and cost-effectiveness of the intervention. Medication for control of blood pressure is used to prevent both stroke and coronary heart disease. Use of cholesterol-lowering drugs for prevention of coronary heart disease depends heavily on assessment of absolute risk; drug therapy should be used cautiously for primary prevention in young adults who are otherwise at low risk. Use of cholesterol-lowering drug therapy in special groups was reviewed in detail in the NCEP report.6
“Guide to Primary Prevention of Cardiovascular Diseases” was approved by the American Heart Association Science Advisory and Coordinating Committee in November 1996.
A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596. Ask for reprint No. 71-0106.
- Copyright © 1997 by American Heart Association
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