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Empowering Patients to Reduce Their CVD Risk

According to the American Heart Association (AHA), nearly 80 million adults have at least one type of cardiovascular disease (CVD), and it is the most deadly disease in the United States. Studies indicate that if CVD were completely eradicated, life expectancy could increase by nearly 7 years. In the July 27, 2010 issue of Circulation, the AHA released a scientific statement on individual-level interventions that are designed to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults. “Individual-level interventions that target dietary patterns, weight reduction, and new physical activity habits often result in impressive rates of initial behavior changes,” says Dariush Mozaffarian, MD, DrPH, who co-chaired the panel that developed the scientific statement. “Unfortunately, many of these behavioral changes are often not maintained for the long term.” The purpose of the scientific statement is to provide evidence-based recommendations on individual-level strategies—for example, in the healthcare setting—for implementing physical activity and dietary interventions in all adults, regardless of racial or ethnic background and socioeconomic demographic. The most efficacious and effective strategies were summarized (Table), and guidelines were provided to translate these strategies into practice. The AHA committee reviewed 74 studies conducted among U.S. adults between 1997 and 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels, physical activity and aerobic fitness, and diet. “There has been an explosion of data emerging on behavioral research and science over the past decade,” Dr. Mozaffarian notes, “and the time was right to systematically review the evidence base for behavioral strategies to improve physical activity and diet to reduce the burden of CVD.” Cognitive...

Updated Guidelines for Heart Failure

The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have updated their guidelines on the diagnosis and management of heart failure (HF). Published jointly in the April 14, 2009 issues of Circulation and the Journal of the American College of Cardiology, the new document revised guidelines previously released in 2005. They reflect the latest research findings on the management of HF, a condition that affects approximately 5.7 million Americans. “The purpose of the guideline update is to provide clinicians with recommendations for care using the best-available evidence,” says Mariell Jessup, MD, FACC, FAHA, who chaired the ACCF/AHA writing committee that updated the guidelines. “The new recommendations are based on randomized clinical trials and important registry data whenever possible.” Key Revisions Among several key updates, the new guidelines incorporate recommendations about the management of acute HF in the hospitalized patient. In addition, the document includes concrete recommendations on the use of a fixed-dose combination of hydralazine and isosorbide dinitrate. The recommendation concerning hydralazine and isosorbide dinitrate was strengthened based on findings from the A-HeFT (African-American Heart Failure Trial) trial. “The complete evidence resulting from A-HeFT was not available at the time of the publication of the last guidelines in 2005,” says Dr. Jessup. “We therefore felt it was important to strengthen the recommendation to Class I so that all self-identified African Americans who remained symptomatic despite optimal medical therapy would be offered the hydralazine/isosorbide dinitrate combination.” In order to keep recommendations in alignment with those from the ventricular arrhythmia guidelines published by the ACCF/AHA, the document also clarifies previous recommendations surrounding the use of implantable cardioverter...
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