The American Heart Association and American Stroke Association identified the top cardiovascular and stroke advances of 2013.
1. Prevention guidelines
In November, the American Heart Association and American College of Cardiology published a set of guidelines on obesity, cholesterol, risk assessment and lifestyle to help patients and clinicians prevent more cases of myocardial infarction and stroke.
Obesity: Obesity is more than a lifestyle issue, according to the guideline, and patients are more likely to stay on track when guided long-term by a trained professional in a healthcare setting. This guideline features a roadmap with multiple different approaches to help patients lose weight and keep it off, starting with evaluating every Americans body mass index. Patients with a BMI of 30 or higher are considered obese and need treatment and chronic follow-up, according to the guideline. In the U.S., nearly 78 million adults are obese.
Lower overall MI and stroke risk, not just cholesterol: After lifestyle changes, cholesterol-lowering statin drugs could benefit about 33 million Americans whose 10-year risk for myocardial infarction and stroke is greater than 7.5%.
Treating for higher overall risk using the criteria in the guideline will replace the previous approach of treating LDL cholesterol to a specific target level.
The guideline recommends that patients and their healthcare providers assess the patients risk of atherosclerotic cardiovascular disease events, and then discuss treatment options, including patient preferences. It also describes four major groups of people for whom the benefit from lowering MI or stroke risk clearly would outweigh the risk of side effects from statin medications. These include patients: 1) with diagnosed ASCVD; 2) with low-density lipoprotein cholesterol of more than 190 mg/dL with no secondary cause; 3) who are ages 40 to 75 with type 2 diabetes, an LDL cholesterol of 70 to 189 mg/dL and no diagnosis of ASCVD; and 4) who have an estimated 10-year risk of ASCVD of more than 7.5%, but dont have diagnosed ASCVD or type 2 diabetes with the LDL levels described above.
Assessing risk of MI and stroke in more people: Updated risk equations for white men and women and a new risk equation for African Americans were published in the risk assessment guideline. To calculate 10-year risk, the equations use race, gender, age, total cholesterol, high-density lipoprotein cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status. Importantly, stroke risk is included, giving patients a better assessment of their future cardiovascular health.
Lifestyle guidelines: Lifestyle recommendations target the many people who need to lower cholesterol and blood pressure. They recommend an overall heart-healthy dietary pattern and 40 minutes of moderate to vigorous aerobic exercise three to four times a week. Dietary patterns should emphasize fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts, and limit red meat and sugary foods and beverages.
To lower blood pressure, the guideline recommends a step-down approach to no more than 2,400 milligrams of sodium a day. To lower it further, the guidelines recommend getting sodium down to 1,500 mg a day.
More on the guidelines: http://blog.heart.org/new-heart-disease-and-stroke-prevention-guidelines-released/
2. Controlling hypertension
Although researchers understand the best ways to treat hypertension, many patients do not know they have it, and only half of the 75% of patients being treated control it to a healthy level.
One important study showed a dramatic increase in patients whose hypertension was controlled from 44% to more than 87% over 10 years through an evidence-based program implemented by a large healthcare provider. It strongly encouraged lifestyle changes, improved tracking of patient information, simplified drug therapies, made in-office blood pressure checks more accessible, provided clinicians more feedback and, overall, treated patients according to scientific evidence.
The program also followed other principles recommended by the American Heart Association, including cost considerations, simple approaches and easy-to-understand patient materials.
3. Combating poor childhood and early adulthood heart health and its aftermath
Two studies looked at heart health in young people. One used the American Heart Associations Lifes Simple 7 health measures to determine how ideal health affected brain function in middle age. The other evaluated a preschool curriculums effect on the health habits of preschoolers and their families.
A study of nearly 3,000 people ages 18 to 30 over 25 years found that those maintaining ideal health had better brain function in mid-life. Each one of the seven health measures avoiding being overweight or obese, eating a healthy diet, not smoking, being physically active and keeping total cholesterol, blood pressure and fasting glucose at goal level improved cognitive function.
A structured curriculum based on Sesame Streets Healthy Habits for Life used in Bogota, Columbia, improved hundreds of preschoolers knowledge, attitudes and heart-healthy habits. The proportion of children who were at a healthy weight increased from 62% to 75%.
4. Getting more people to cardiac rehabilitation has big results
Following hospitalization for cardiovascular disease, simple changes can greatly increase enrollment and participation in cardiac rehabilitation, and rehabilitation significantly lowered the death rate after heart bypass surgery, according to several 2013 studies. Not enough eligible patients participate in cardiac rehabilitation, despite known benefits, said study authors.
Setting outpatient rehabilitation appointments soon after leaving the hospital improved participation significantly, as did providing a non-medical navigator or coach while patients were in the hospital. Hospitals promoting cardiac rehabilitation and more certifications for rehab programs also were effective.
The 10-year death rate for people who participated in cardiac rehabilitation after heart bypass surgery was 50% lower than for those who did not participate.
5. Breakthroughs in congenital heart disease genetics
Two new papers significantly increased understanding of the genetics of congenital heart disease. One identified 400 genes potentially responsible for congenital heart disease, and found that 10% of mutations leading to severe congenital heart disease were new and not passed down by a parent.
Another study showed for the first time that mutations within a genetic pathway that regulates early development may be responsible for congenital heart disease, and may also have a link to autism.