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Treatment Recommendations Updated for Heart Patients

Elizabeth Thompson Beckley

In light of recent research supporting assertive risk-reduction treatment for patients with established coronary heart disease (CHD), in May the American Heart Association and American College of Cardiology (ACC) published updated guidelines on secondary prevention.¹

"This growing body of evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves quality of life for these patients," the consensus statement says.

Published as an update to the 2001 guidelines, the new recommendations include lowering the target for LDL cholesterol. LDL should be <100 mg/dl for all patients with CHD and other clinical forms of atherosclerotic disease, and it is "reasonable" to treat to <70 mg/dl in these patients, according to the new guidelines. If the lower target is selected, the authors say providers should take care to increase statin therapy slowly to test each patient's response.

The authors note that this guideline does not change the 2004 Adult Treatment Panel III (ATP III) recommendations for patients who do not have established heart disease but do have diabetes or multiple risk factors and a >20% 10-year risk level for CHD. For these high-risk patients, the recommended LDL target of <100 mg/dl remains.

Patients with diabetes should maintain glycated hemoglobin (A1C) levels <7%, according to the guidelines.

Physical activity recommendations have increased from 30–60 minutes of activity 3–4 times per week to 30–60 minutes 7 days per week, or a minimum of 5 days per week, plus resistance training 2 days per week. Weight management targets remain a body mass index of 18.5–24.9 and a waist circumference of <101.6 cm (<40 in) for men and <88.9 cm (<35 in) for women.

Other goals in the new guidelines include:

• A complete cessation of smoking and no exposure to environmental tobacco smoke;
  
• Blood pressure <140/90 mmHg or <130/80 mmHg if the patient has diabetes or kidney disease;
  
• If triglycerides are 200 mg/dl, non-HDL cholesterol should be <130 mg/dl, and it is reasonable to aim for <100 mg/dl;
  
• To lower the dose of aspirin for chronic therapy to 75–162 mg per day (the previous guidelines recommended a dose of 75–325 mg per day);
  
• A first-time recommendation of flu vaccine for people with chronic cardiovascular disorders due to their increased risk of complications from the flu.
  

Footnotes

FYI

The complete "HA /ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update" is available at www.americanheart.org and www.acc.org.

AHA and ACC recommend the use of programs such as AHA's "get with the guidelines" or ACC's "guidelines applied to practice" to identify appropriate patients for therapy and to help providers achieve the guidelines.

References

1. Smith, SC, Allen J, Blair, SN, et al.: AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 113: 2363–2372, 2006.[Free Full Text]

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Beckley, E. T. Search for Related Content PubMed Articles by Beckley, E. T. Social Bookmarking                What's this?