UCI Health heart experts support new cardiovascular disease prevention guidelines

November 12, 2013

UCI Health heart disease specialists fully support new guidelines for the American public for prevention of cardiovascular disease by the American Heart Association and American College of Cardiology. These guidelines, which were released today, include revised standards for cardiovascular disease risk assessment, cholesterol, obesity and lifestyle management.

“These long-awaited documents were developed by a panel of national experts using the strictest evidence-based methodology to provide updated guidance on what clinicians should be doing to best identify persons at risk for cardiovascular disease,” said Nathan D. Wong, PhD, professor and director of the Heart Disease Prevention Program at UC Irvine and immediate past president of the American Society for Preventive Cardiology. He was not involved with the development of the guidelines.

“They are based on a large body of research evidence from the past two decades and in some cases, such as with cholesterol treatment, reflect the first significant revised guidelines in more than a decade,” he added.        

Research done by Wong and his colleagues over the past two decades, and in collaboration with experts around the country has helped to support some of the new guidelines.

Cultural changes needed

“Some of the new approaches being recommended will require a change in culture in order to be successfully implemented,” said Dr. Shaista Malik, medical director of UCI Health’s Preventive Cardiology Program. “We plan to support these new guidelines and help educate our patients and the public as to their necessity and importance.”

“These important new practice guidelines address how best to identify persons at increased risk of cardiovascular disease, who specifically should be taking cholesterol-lowering treatment, the latest recommendations for managing obesity, and what evidence-based lifestyle measures should be used for prevention of cardiovascular disease,” Wong added.

Revised blood pressure guidelines are in development and will be released later.

Key highlights of the guidelines include:

  • Assessing risk of cardiovascular disease: The guidelines recommend use of a new risk-scoring system, the “Pooled Cohort Equations,” which estimates 10-year risk of total cardiovascular disease. This system is appropriate for a wider range of racial and ethnic groups. Previous risk scores (such as Framingham) were applicable mainly to Caucasians. Besides estimating risk of cardiovascular disease, these scores are also used to determine who should be given preventive treatments, such as statin medications.
  • Revised recommendations of those who should receive statin therapy: Moderate or high intensity statin medications are recommended for those with:

a.)  “Bad” LDL-cholesterol of 190 mg/dl or higher,

b.)  Cardiovascular disease and aged 75 years or under, or diabetes (type 1 or 2 aged 40-75 years) regardless of LDL-cholesterol levels, or

c.)  Those aged 40-75 years with previously identified 10-year cardiovascular risks of 7.5 percent or greater when LDL-cholesterol levels are less than 190 mg/dl.

       Specific-goal LDL cholesterol levels are no longer being recommended. This is a major change from the previous guidelines issued in 2001, which called for both initiation and goal LDL-C levels at each level of risk.
  • Recommendations for other testing to further identify who should be on treatment: If, after such a risk assessment, a risk-based treatment decision is uncertain, assessment of one or more of the following – family history, high-sensitivity C-reactive protein, coronary artery calcium score, or ankle-brachial index – may be considered to inform treatment decision making. “We now have greater guidance from large-scale studies done in the past decade regarding the utility of each of these tests for risk prediction, as well as for guiding treatment decisions,” Wong said.    
  • Dietary and physical activity recommendations: A fat-restrictive diet containing no more than 7-8 percent of calories from saturated fat, and one low in sodium (no more than 2,400 milligrams a day with a recommendation to reduce down to 1,500 milligrams, which can help lower blood pressure) and high in vegetables and fruits that can be achieved by following the DASH dietary pattern, the USDA Food Pattern or the American Heart Association diet plans. Moderate to vigorous-intensity aerobic physical activity should include 3-4 sessions per week lasting on average 40 minutes per session is recommended to lower cholesterol or blood pressure.
  • Comprehensive lifestyle management: Strong recommendations for comprehensive lifestyle management, including reduced calorie intake and increased physical activity for overweight and obese individuals should be done as a high-intensity individual or group program lasting at least six months.
  • Evaluation of overweight and obesity: Body mass index should be calculated annually or more frequently — a baseline score of 25-29 continues to define overweight and 30 and over defines obesity. These levels increase risk of diabetes, cardiovascular disease and total mortality. Waist circumference should be measured during annual visits, and more frequently in overweight or obese individuals. Waist circumference, in particular, has been shown to be a strong predictor for risk for developing diabetes and cardiovascular disease. Levels over 40 inches in men and 35 inches in women define abdominal obesity. Patients should be counseled that even modest weight loss (3-5 percent of body weight) can result in meaningful benefits in reducing diabetes and cardiovascular disease risk factors.

Proactive healthcare needed

Wong and Malik feel it is critical that healthcare providers and organizations become familiar with the new guidelines and develop programs along with advocacy efforts from the American Heart Association and other societies that will help to empower patients to adhere to the recommendations.

“Close cooperation between the healthcare, governmental, and private sectors in prevention efforts and educating the public about how to best implement the new guidelines is essential to help us achieve year 2020 goals for reducing cardiovascular disease by 20 percent” Wong said.

Tools available

The American Heart Association has made a series of web tools available for download:

  • Assessment of Cardiovascular Risk
  • Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
  • Lifestyle Management to Reduce Cardiovascular Risk
  • Management of Overweight and Obesity in Adults

Guideline details

The new guidelines from the American College of Cardiology and the American Heart Association are also published online as follows (subscription may be needed):

More information about preventing heart disease and promoting cardiovascular wellness can be found at the UCI Health Heart Disease Prevention Program. Learn more about individualized care at the UCI Health Preventive Cardiology Program.