New ACC/AHA Prevention Guidelines Address Blood Cholesterol, Obesity, Healthy Living and Risk Assessment

The ACC and the American Heart Association (AHA), in collaboration with the National Heart, Lung, and Blood Institute (NHLBI) and other specialty societies, have released four guidelines focused on the assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk and management of elevated blood cholesterol and body weight in adults.

These four prevention guidelines released Nov. 12 were among five initially commissioned by NHLBI starting in 2008 and transitioned to the ACC and AHA in June 2013 as part of a collaborative arrangement to facilitate their completion and publication. A fifth guideline addressing hypertension will be initiated in early 2014. Each provides important updated guidance for primary care providers, nurses, pharmacists and specialty medicine providers on how best to manage care of individuals at risk for cardiovascular-related diseases based on the latest scientific evidence.

Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

The Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults focuses on the use of statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in higher risk patients. The Expert Panel recommends statin therapy for individuals at increased ASCVD risk who are most likely to experience a net benefit in terms of the potential to reduce ASCVD events and the potential for adverse effects. They also suggest the use of statins to prevent both nonfatal and fatal ASCVD events — an approach, they say, that can not only reduce the large burden of disability from nonfatal stroke and nonfatal CHD events, but also reduce increasing health care costs. According to the guideline, there is no evidence to support continued use of specific LDL-C and/or non-high-density lipoprotein cholesterol (non-HDL-C) treatment targets. Rather, the appropriate intensity of statin therapy should be used to reduce risk in those most likely to benefit.

Guideline for the Management of Overweight and Obese Adults

The Guideline for the Management of Overweight and Obese Adults addresses the appropriateness of the current BMI and waist circumference cutpoints used to determine risk in overweight and obese adults across diverse populations; the impact of weight loss on risk factors for cardiovascular disease and type 2 diabetes; optimal behavioral and dietary intervention strategies; lifestyle treatment approaches, such as community-based programs, for weight loss and weight loss maintenance; and benefits and risks of various bariatric surgical procedures.

According to the Expert Panel, the "information will help providers decide who should be recommended for weight loss, and what health improvements can be expected." However, they suggest that further research into the benefits of weight loss and the risks associated with overweight and obesity are needed. In addition, the authors note that further research is needed into the role of new weight loss drugs, as well as the type of patient most likely to benefit from surgical interventions.

Guideline for Lifestyle Management to Reduce Cardiovascular Risk

The Guideline for Lifestyle Management to Reduce Cardiovascular Risk provides updates to dietary and physical activity recommendations for adult patients with high LDL-C and/or hypertension. Not surprisingly, the recommendations for lowering both LDL-C and blood pressure included a focus on aerobic exercise three to four times a week and a diet high in vegetables, fruits and whole grains. The Expert Panel did provide additional sodium recommendations — no more than 2,400 mg of sodium/day — for treating hypertension. They noted that further reduction of sodium intake to 1,500 mg/day associated with even greater reduction in hypertension, and is recommended if achievable by the patients.

Assessment of Cardiovascular Risk

The Guideline for the Assessment of Cardiovascular Risk offers a new approach to risk assessment. According to the Expert Panel responsible for the risk assessment guideline, their recommendations represent a step forward in the prevention of ASCVD. "The ability to estimate risk for a more broadly based ASCVD outcome that is more relevant to contemporary populations, especially women and African Americans, and the ability to provide risk estimates specific to African Americans, are the major advances of this approach," they note. "Promoting lifetime risk estimation may represent an additional step forward in supporting lifestyle behavior change counseling efforts."

Keywords: Bariatric Surgery, Stroke, Life Style, National Heart, Lung, and Blood Institute (U.S.), Sodium, Weight Loss, Exercise, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Diabetes Mellitus, Type 2, Hypercholesterolemia, Waist Circumference, Cholesterol, Body Mass Index, Secondary Prevention, Cardiovascular Diseases, Obesity, Diet, Anti-Obesity Agents, Risk Assessment, Hypertension, Primary Health Care

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