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Risk%20Factors%20and%20Prevention%20of%20CVD_1 - 842 PART 5...

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842 PART 5 1 Medical Nutrition Therapy A landmark achievement of epidemiologic research has been the identification of risk factors for atherosclerosis, CHD, and stroke (Box 32 - 1). The primary prevention of these CVDs involves the assessment and management of the risk factors in the asynlptomatic person. Persons with mul - tiple risk factors are the target population for primary pre - vention (NCEP, 2002). h s k factor reduction has been shown to reduce CHD in persons of all ages. Ln a large study of men, 62% of coronary events could have been pre - vented if the men would have adopted a healthy lifestyle (eating a heart - healthy diet, exercising regularly, managing weight, and not using tobacco) and adhered to taking lipid and hypertension nledications (Chiuve et al., 2006). Com - puter modeling studies have shown that approximately one quarter of the decline in CND is attributable to improved treatment and 53% to 72% may be the result of positive changes in risk factors (Iaatikainen et al., 2005). Over 200 risk factors have been identified. Only those that are the most prevalent, have strong evidence, or are related to diet are presented in h s chapter. Prevention of CHD and Stroke In the medical model, primary prevention of CVD, in particular CHD and stroke, involves altering risk factors toward a healthy patient profile. CHD and stroke share most of the same risk factors. For ischemic stroke, athero - sclerosis is the underlying disease. Therefore optimal I BOX 32 - 1 1 Modifiable Cardiovascular Risk Factors . I ,' - Markers in Blood . ; . . .-2 , Lipoprotein profile ~ow~densi~-li~o~rotein chalesterol Total tiiglycerides High - density - lipoprotein cholesterol Inflammatory Markers Fibrinogen C - Reactive protein Lifestyle Risk Factors \ Tobacco Physical inactivity Poor &et Stress Excessive alcohol consumption Related Diseases/Syndrome Hypertension Diabetes Obesit y Metabolic syndrome stone of treatment for elevated LDL. The focus The American Heart Association (AHA) reco Assessing Risk Several methods have been proposed to assess yrnptomatic persons. The first is from the Fr CHD, Chronic heart disease. BOX 32 - 2
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LDL-C Goal Initiate TLC Consider Drug Therapy " sk: CHD* or CHD risk equivalents? < 100 mg/dl r 100 mg/dl# r 100 mg/dltt (< 100 mg/dl: consider drug options) " 2 13 0 mg/dl (1 00 - 129 mg/dl; consider drug options)** 2130 mg/dl 2 160 mg/dl \ 2 160 mg/dl 2 190 mg/dl (160 - 189 mg/dl: LDL- lowering drug optional) c 10 - year risk calculators are available at www.nhlbi.nih.gov/guidelines/cholesterol. t high risk or moderately high risk who has lifestyle - related risk factors (e.g., obesity, inactivity, elevated mgl~cerides, low HDL - C, or drome) is a candidate for therapeutic lifestyle changes to modify these risk factors regardless of LDL - C level. - risk person has high miglycerides or low HDL cholesterol, combining a 6brate or nicotinic acid with an LDL - lowering drug can be considered.
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Risk%20Factors%20and%20Prevention%20of%20CVD_1 - 842 PART 5...

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