Lifestyle, risk factor, and therapeutic targets for cardiovascular disease prevention in all high risk people and families
| People with atherosclerotic cardiovascular disease | Asymptomatic people at high risk (CVD risk ⩾20% over 10 years) of developing CVD | People with diabetes mellitus | |
|---|---|---|---|
| Lifestyle | |||
| Smoking habit | Stop smoking completely | ||
| Diet | Total intake of fat ⩽30% of total energy intake | ||
| Intake of saturated fats to ⩽10% of total fat intake | |||
| Intake of dietary cholesterol <300 mg/day | |||
| Replace saturated fats by an increased intake of monounsaturated fats | |||
| Increase intake of fresh fruit and vegetables to at least five portions per day | |||
| Regular intake of fish and other sources of omega 3 fatty acids (at least 2 servings of fish per week) | |||
| Limit alcohol intake to <21 units per week (men) and <14 units per week (women) | |||
| Limit intake of salt to <100 mmol/l per day (<6 g of sodium chloride or <2.4 g of sodium per day) | |||
| Physical activity | Regular aerobic physical activity of at least 30 mins per day, most days of the week, should be taken (for example, fast walking/swimming) | ||
| Other risk factors | |||
| Body weight distribution | Waist circumference | ||
| White caucasians: men <102 cm, women <88 cm; Asians: men <90 cm, women <80 cm; BMI <25 kg/m2 | |||
| Blood pressure | <130 mm Hg systolic and <80 mm Hg diastolic | <140 mm Hg systolic and <85 mm Hg diastolic | <130 mm Hg systolic and <80 mm Hg diastolic |
| Lipids | |||
| TC | <4.0 mmol/l | <4.0 mmol/l | <4.0 mmol/l |
| or a 25% reduction | or a 25% reduction | or a 25% reduction | |
| LDL-C | <2.0 mmol/l | <2.0 mmol/l | <2.0 mmol/l |
| or a 30% reduction | or a 30% reduction | or a 30% reduction | |
| Glucose | |||
| FPG | ⩽6.0 mmol/l | ⩽6.0 mmol/l | ⩽6.0 mmol/l |
| HbA1c <6.5% | |||
| Cardioprotective therapies | |||
| Antiplatelet drugs | Aspirin 75 mg/daily | Aspirin 75 mg/daily | Aspirin 75 mg/daily |
| For people at high risk once blood pressure is controlled to audit standard: systolic <150 mm Hg and diastolic <90 mm Hg | |||
| β blockers | Prescribe in all people following myocardial infarction | ||
| ACE inhibitors/AII receptor blockers | Prescribe in people with heart failure or LV dysfunction and consider in other people with coronary disease and normal LV function if blood pressure is not at target | Prescribe in people with renal dysfunction and microalbuminuria | |
| Calcium channel blockers | Consider in people with coronary disease if blood pressure is not at target | ||
| Statins | Prescribe in all people with symptomatic atherosclerotic disease to achieve the total and LDL cholesterol targets | Prescribe in all people to achieve the total and LDL cholesterol targets | Prescribe in (1) all people aged 40 years or more with either type 1 or 2 diabetes; and (2) for people aged 18–39 years with either type 1 or 2 diabetes and who have at least one of the following: retinopathy, nephropathy, poor glycaemic control (HbA1c >9%), elevated blood pressure requiring drug therapy, total cholesterol >6 mmol/l, features of metabolic syndrome, family history of premature CVD. |
| Anticoagulants | Consider in people at high risk of systemic embolisation | ||
| Blood relatives | |||
| Parents, siblings, and offspring | First degree relatives of people with premature atherosclerotic disease (men <55 years and women <65 years) to be screened for cardiovascular risk factors including lipids | ||