Table 6

 Lifestyle, risk factor, and therapeutic targets for cardiovascular disease prevention in all high risk people and families

People with atherosclerotic cardiovascular diseaseAsymptomatic people at high risk (CVD risk ⩾20% over 10 years) of developing CVDPeople with diabetes mellitus
Smoking habitStop smoking completely
DietTotal 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 activityRegular 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 distributionWaist 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
    TC<4.0 mmol/l<4.0 mmol/l<4.0 mmol/l
or a 25% reductionor a 25% reductionor a 25% reduction
    LDL-C<2.0 mmol/l<2.0 mmol/l<2.0 mmol/l
or a 30% reductionor a 30% reductionor a 30% reduction
    FPG⩽6.0 mmol/l⩽6.0 mmol/l⩽6.0 mmol/l
HbA1c <6.5%
Cardioprotective therapies
Antiplatelet drugsAspirin 75 mg/dailyAspirin 75 mg/dailyAspirin 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 blockersPrescribe in all people following myocardial infarction
ACE inhibitors/AII receptor blockersPrescribe 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 targetPrescribe in people with renal dysfunction and microalbuminuria
Calcium channel blockersConsider in people with coronary disease if blood pressure is not at target
StatinsPrescribe in all people with symptomatic atherosclerotic disease to achieve the total and LDL cholesterol targetsPrescribe in all people to achieve the total and LDL cholesterol targetsPrescribe 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.
AnticoagulantsConsider in people at high risk of systemic embolisation
Blood relatives
Parents, siblings, and offspringFirst degree relatives of people with premature atherosclerotic disease (men <55 years and women <65 years) to be screened for cardiovascular risk factors including lipids