Table 3 Guide to primary prevention of cardiovascular disease

Smoking:

Ask about smoking status as part of routine evaluation. Reinforce smoking status.

   Goal

Strongly encourage patient and family to stop smoking.

   complete cessation

Provide counseling, nicotine replacement, and formal cessation programs as appropriate.

Blood presure control:

Measure blood pressure in all adults at least every 2.5 years.

   Goal

Promote lifestyle modification: weight control, physical activity, moderation in alcohol intake, and moderate

   <140/90 mmHg

   sodium restriction.

If blood pressure >140/90 mmHg after 3 months of life habit modigfication of if initial blood pressure

   >160/100 mmHg: add blood pressure medication, individualize therapy to patients's other requirements

   and characteristics.

Cholesterol management:

Ask about dietary habits as part of routine evaluation.

   Primary goal

Measure total and HDL cholesterol in all adults >19 years and assess positive and negative risk factors every 5 years.

   LDL <160 mg/dl

For all persons: promote AHA Step I diet (≤ 30% fat, <10% saturated fat, <300 mg/day cholesterol), weight

   if 0-1 risk factors

   control, and physical activity.

   or

Measure LDL if total cholesterol ≥ 240 mg/dl or ≥ 200 mg/dl with ≥ 2 risk factors or if HDl <35 mg/dl.

   LDL <130 mg/dl

If LDL

Risk factors: age (men >45 years, women >55 years)

   if ≥ 2 risk factors

   ≥ 160 mg/dl with 0-1 risk factors or

or postmenopausal), hypertension, diabetes, smoking,

   Secondary goals

   ≥ 130 mg/dl on 2 occasions with ≥ 2 risk factors;

HDL<35 mg/dl, family history of CHD in first-degree

   HDL >35 mg/dl;

   then Start Step II Diet (≤ 30% fat,

relatives <65 years) HDL ≥ 60 mg/dl:

   TG <200 mg/dl

   <7% saturated fat, <200 mg/dl cholesterol)

Substract 1 risk factor from the number of risk factors.

   and weight control.

Rule out secondary causes of high LDL

   (LFTs, TFTs, UA).

If LDL:

   ≥ 160 mg/dl plus two risk factors; or

   ≥ 190 mg/dl; or

   ≥ 220 mg/dl in men <35 years; or in premenopausal

women; then consider adding drug therapy to

diet therapy for LDL levels > those listed above

that persist despite Step II Diet.

Suggested drug therapy for high LDL levels (≥ 160 mg/dl)

   drug selection priority modified according to TG level)

Emphasize weight management,

physical activity, avoidance of

cigarette smoking. Niacin raises HDL.

Consider niacin if patient has ≥ 2 risk

factors and high LDL (except patients

with diabetes).

If LDL goal not achieved, consider combination drug therapy

Physcial activity:

Ask about physical activity status and exercise habits as part of routine evaluation.

   Goal

Encourage 30 min of moderate-intensity dynamic exercise 3-4 times per week as well as increased physical

   Increase amount of

   activity in daily life habits for persons who are active.

   exercise regularly

Encourage regular exercise to improve conditioning and optimize fitness level.

   3-4 times per week

Advise medically supervised programs for those with functional capacity and/or comorbidities.

   for 30 min

Promote environmental factors conducive to health (eg golf courses that permit walking).

Weight management:

Measure patient's weight and height, BMI, and waist-to-hip ratio at each visit as part of routine evaluation.

   Goal

Start weight management and physical activity as appropriate. Desirable BMI range 21-25 kg/m². BMI of

   Achieve and maintain

   25 kg/m² corresponds to percentage desirable body weight of 110%; desirable waist-to-hip ratio for men,

   desirable BMI

   <0.9; for middle-aged and elderly women, <0.8).

   (21-25 kg/m²)