By David Douglas
NEW YORK (Reuters Health) – A new guideline from the American College of Cardiology and the American Heart Association emphasizes social determinants of health and calls for their incorporation into shared decision-making to optimize prevention of cardiovascular disease.
In a July 31 online synopsis in JAMA Cardiology, senior author Dr. Roger S. Blumenthal of the Johns Hopkins University, Baltimore, Maryland, and colleagues emphasize, “Patient-centered care is a foundational aspect of this guideline and an essential part of its effective implementation.”
As Dr. Blumenthal told Reuters Health by email, “Better lifestyle habits are the cornerstone of prevention and good health. We all should strive to increase the amount of fruits, vegetables, fiber, fish and minimize fried foods, processed meats, foods with high amounts of sugar, and sugar sweetened beverages.”
Development of the guideline, which is directed toward care of adults who are free of atherosclerotic cardiovascular disease, involved an array of clinicians, cardiologists, health services researchers, epidemiologists, nurses and others. An extensive evidence review was conducted including randomized clinical trials, systematic reviews, and meta-analyses.
Among their recommendations beyond team-based care and the general need for a healthy diet, is to “replace saturated fat with monounsaturated and polyunsaturated fats and reduce dietary cholesterol and sodium.”
In addition, body mass index should be calculated and a measurement of waist circumference should be considered at least annually. Patients who are overweight, say the investigators, “benefit from counseling and comprehensive lifestyle interventions, including caloric restriction, to achieve and maintain weight loss.”
Dr. Blumenthal added, “It is also so important to aim for more brisk activity on a daily basis. It is best to aim for an average of 40 minutes a day.” In particular, the guidelines suggest that for those unable to meet such minimums, “engaging in at least some moderate to vigorous activity can still be beneficial.”
“Avoidance of tobacco products is also key to good health,” Dr. Blumenthal pointed out. In fact, the recommendations say, “All adults should be assessed at every health care visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. A combination of behavioral interventions plus pharmacotherapy maximizes tobacco quit rates.”
The benefits of these measures are in little doubt, but still, the researchers write, “Further studies are also needed to determine optimal strategies to enhance uptake of and adherence to physical activity and nutrition recommendations.”
JAMA Cardiol 2019.