2021 cardiovascular disease prevention: On the afternoon of August 30, the 2021 ESC clinical practice guide for cardiovascular disease prevention was released during the 2021 ESC annual meeting. On the basis of reviewing the newly published research data in recent years, the new version of the guide has made a series of updates to the 2016 version of the guide.
1.Lifestyle intervention: smoking cessation, alcohol restriction, less salt and sugar, more exercise and anti obesity
The guideline points out that the main risk factors of atherosclerotic cardiovascular disease (ASCVD) are cholesterol, blood pressure, smoking, diabetes and obesity.
Psychosocial stress and air pollution are related to the risk of ASCVD. Chronic kidney disease (CKD) is an independent risk factor for ASCVD, and ASCVD is the main cause of death of CKD. In terms of cardiovascular adverse events, common COPD drugs are usually safe. Chronic inflammation increases the risk of cardiovascular disease.
Migraine, especially migraine with aura, is an independent risk factor for stroke and ischemic heart disease. The combination of hormonal contraceptives and smoking increases the risk of ischemic stroke in patients with migraine aura.
The guidelines recommend that all adults combine aerobic exercise with resistance exercise to reduce sedentary time, and moderate to intense physical activity is beneficial. A healthy diet can reduce the risk of cardiovascular disease and other chronic diseases. The guidelines point out that the shift from a more animal based food model to a plant-based diet may reduce cardiovascular disease.
Achieving and maintaining a healthy weight through lifestyle changes can have a beneficial impact on risk factors (blood pressure, blood lipids, glucose metabolism) and reduce the risk of CVD. When diet and physical activity changes and other routine non-invasive interventions are ineffective, weight loss surgery should be considered for high-risk groups; Anti obesity drugs with cardiovascular protective effects can also be considered.
The lifestyle risk of patients with mental disorders increases sharply and needs to be identified and treated. Mental health care can improve stress symptoms and quality of life, reduce the risk of suicide, and may improve cardiovascular outcomes.
Quitting smoking can quickly reduce the risk of CVD, which is the most cost-effective strategy to prevent ASCVD. It is recommended to limit drinking or abstain from drinking, with a maximum of 100g per week. Patients should also be informed that alcohol is high energy, provides 7kcal / g and does not contain nutrients. Limit free sugar intake, including sugary drinks. It is recommended to reduce salt intake.
2,Blood lipid, blood pressure and blood glucose management
Blood lipid management
The effect of low density lipoprotein cholesterol (LDL-C) on CVD risk appears to be determined by baseline levels and the total duration of LDL-C exposure. Therefore, the lower the LDL-C level, the better, and early intervention should be carried out to reach the standard as soon as possible. The guidelines recommend statins as the first choice for reducing cardiovascular risk in high-risk individuals with hypertriglyceridemia (triglyceride > 2.3mmol / L).
Blood pressure management
The guideline states that when hypertension is suspected, the diagnosis should be confirmed by multiple office blood pressure measurements or ABPM or HBPM. Lifestyle intervention is applicable to all patients with hypertension and can delay the demand for drug treatment or the antihypertensive effect of supplementary drug treatment. When the blood pressure in the consulting room is ≥ 140 / 90mmHg, or the blood pressure in adults is ≥ 160 / 100 mmHg, antihypertensive drug treatment is recommended.
Blood glucose management
Lifestyle changes are crucial for type 2 diabetes. Managing hyperglycemia can reduce the risk of microvascular complications and reduce the risk of cardiovascular disease.
The majority of patients with type 1 or type 2 diabetes had a HbA1c target of < 7%; Blood glucose targets for the elderly and the infirm should be relaxed. For type 1 diabetes, intensive management of hyperglycemia can reduce the risk of microvascular and macrovascular complications and premature death. The recommended HbA1c target is 6.5% – 7.5% (48-58 mmol / mol).
All patients with ASCVD need low-dose aspirin antiplatelet therapy for secondary prevention, and clopidogrel can be used to replace aspirin intolerance. For patients at high risk of gastrointestinal bleeding, the combination of proton pump inhibitors is recommended. For patients with high or very high cardiovascular risk, low-dose aspirin can be considered for primary prevention. In addition, anti-inflammatory therapy is a promising strategy for the prevention of cardiovascular disease.
Unhealthy lifestyle has a great impact on cardiac metabolic diseases
Coincidentally, in recent years, the European Journal of Cardiology (EHJ) published a study on the chronic disease prospective study (CKB) project, announces the impact of unhealthy lifestyles (smoking, drinking, unhealthy diet, physical inactivity and unhealthy body shape) on cardiac metabolic diseases such as ischemic heart disease, stroke and diabetes.
Specifically, body size has the strongest correlation with cardiac metabolic diseases, and smoking has the strongest correlation with death, which can increase the risk of death by 35%.
Previous studies in the CKB project show that adherence to healthy lifestyle can prevent 43.2% of ischemic heart disease, 39.1% of ischemic stroke and 78.8% of diabetes. This study further confirms the role of lifestyle intervention in primary prevention of cardiac metabolic diseases (heart disease, stroke, diabetes), and confirms the possibility of life-style intervention in two level prevention of cardiac metabolic diseases.
Many research and prevention guidelines reveal that unhealthy lifestyles must bring unhealthy health. Some experts pointed out that among the ten modifiable risk factors for cardiovascular death, seven are unhealthy lifestyles. Therefore, lifestyle intervention should be the main strategy to prevent cardiovascular disease.
People should keep healthy lifestyles away from obesity, diabetes, hypertension and dyslipidemia.