Prevention Primary prevention strategies directed at: o Healthy general population – Section 3 o Individuals with multiple CV risk factors or very high levels of a single CV risk factor – Section 4 o Individuals who are at high risk for a CV event – Section 5 & 6 Secondary prevention strategies directed at individuals who: o Have established CVD. CVD includes: Coronary heart disease (CHD) Cerebrovascular accident (CVA) Peripheral artery disease (PAD) Asymptomatic individuals with: o “Silent” myocardial ischemia (MI) detected by non-invasive testing. o Significant atheromatous plaques in any vascular tree detected by imaging. • CV risk factors may be: Non-modifiable – increasing age, gender, family history of premature CVD, ethnicity. Modifiable – diet and dietary patterns, smoking, physical inactivity,
obesity/overweight, hypertension, dyslipidemia and pre-diabetes/diabetes. primary prevention will be based on Screening at >30 years of age. (Section 3.2, pg 31) Opportunistic rather than mass screening. The use of the Framingham Risk Score (FRS) General CVD Risk Score to assess future CV risk Management – General measures • Nutrition – A diet high in fibre, fruits and vegetable, wholegrain, low in salt and saturated/trans-fat is associated with lower CV risk. A healthy food portion recommendation is the #QuarterQuarterHalf plate ( Tables 5 & 6, pg 22-23) • Physical activity (PA): Any amount of PA is better than none. Regular PA reduces all causes and CV mortality. • Smoking: Is an independent and strong risk factor for CVD. There is no safe level of exposure to second-hand tobacco smoke. Smoking should be strongly discouraged and individuals referred to the MQuit services. • Overweight and obesity Overweight and obese individuals should be counselled on lifestyle changes that can produce at least a 5-10% weight loss. ( Appendix 10, pg 175) A small 3-5% weight loss itself is associated with a clinically significant reduction in CVD risk factors – blood pressure (BP), blood glucose and lipid. Bariatric surgery may be considered as a treatment option for obesity if body mass index (BMI): o >35 kg/m 2 with or without co-morbidities. o >32 kg/m 2 with co-morbidities. o >30 kg/m 2 if central obesity + 2 CV risk factors. Bariatric surgery has been shown to improve CV risk factors in the short term. There is a reduction in CV events and mortality during long term follow up. • At present, national policies are mainly directed at tobacco control, salt reduction and modifying the obesogenic environment. Treatment of individual risk factors (Table 4, pg 21) • Treating BP and lipids (particularly low density lipoprotein cholesterol (LDL-C)) to the recommended targets have been consistently shown to reduce CVD. • Good glycemic control reduces the risk of microvascular diseases (retinopathy, nephropathy) in the short term and reduces CV events (MI and CV mortality) in type 2 diabetes mellitus (T2DM) during long term follow up (Legacy effect). In patients with CVD, the newer diabetic medications have shown to cause a reduction in composite CV events.
- Winter '19
- Professor Robert