HomeLifestyleHealth & FitnessHow can you prevent sudden death risk from heart disease or stroke?

How can you prevent sudden death risk from heart disease or stroke?

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Up to 90 percent of the risk of having a heart attack, stroke, or peripheral arterial disease (PAD) can be attributed to smoking, bad eating habits, inactivity, abdominal obesity, hypertension, elevated blood lipid levels, diabetes, psychosocial factors, or alcohol.

These guidelines are focused on atherosclerotic cardiovascular disease (CVD), a condition characterised by hardening of the arteries.

As the insides of the arteries get clogged with fatty deposits, they become incapable of supplying the body with enough blood. This process, in which arteries become fully clogged, is the primary cause of heart attacks, strokes, PAD, and sudden death. The most effective strategy to prevent these illnesses is to maintain a healthy lifestyle throughout one’s life, particularly by abstaining from smoking, and by treating risk factors.

Recommendations are made for healthy persons of all ages, as well as for patients with pre-existing cardiovascular disease or diabetes. Identifying who will benefit the most from preventative medicines, such as blood pressure and lipid lowering medications, is critical to prevention efforts, and hence the recommendations’ assessment of CVD risk is a cornerstone.

These targets for blood lipids, hypertension, and glycaemic regulation in diabetes are consistent with those proposed in current ESC guidelines on dyslipidemias, high blood pressure, and diabetes. The present guidelines take a gradual approach to increasing the intensity of preventive treatments, always taking into account possible benefit, co-morbidities, psychological aspects, and patient preferences. For example, among healthy individuals, the stepwise approach begins with universal recommendations: smoking, following a healthy lifestyle, and managing a systolic blood pressure less than 160 mmHg. The recommendations are then tuned to the 10-year risk of cardiovascular disease (calculated by a health professional using available risk scores).

“Individualised decisions using risk estimation and a stepwise approach to therapies is more complex than a one-size-fits-all approach, but reflects the diversity of patients and patient characteristics in everyday clinical practice, and is essential to give the right patient the right treatment,” said guidelines task force chairperson Professor Frank Visseren of the University Medical Centre Utrecht, the Netherlands.

A new part is devoted to risk awareness in the context of shared decision making. Individuals should get an understanding of their risk, the projected risk reduction through preventive steps, the benefits and drawbacks of intervention, and their own personal priorities. In healthy individuals, the conventional technique is to calculate the likelihood of developing CVD within the next ten years. Estimates of lifetime risk and lifetime benefit of preventative action may be more relevant for young people, as their 10-year risk is generally low.

Among all preventive strategies, quitting smoking has the potential to be the most successful, with significant reductions in heart attacks and death. CVD risk is fivefold greater among smokers under the age of 50 than in nonsmokers. All smokers should be urged to quit, and passive smoking should be prevented wherever possible. The guidelines specifically mention for the first time that smoking cessation is encouraged and remains helpful regardless of weight gain. While data suggests that e-cigarettes may be more effective at smoking cessation than nicotine replacement treatment, the long-term implications on cardiovascular and lung health are unknown, and dual use with tobacco cigarettes should be avoided.

Adults of all ages should aim for at least 150–300 minutes of moderate-intensity physical activity per week, or 75–150 minutes of vigorous-intensity, aerobic physical activity per week, or an equivalent mix. It is advisable to limit idle time and engage in at least light activity throughout the day for the first time. Additionally, consider using wearable activity monitors to enhance your activity level.

The guidelines state: “Most important is to encourage activity that people enjoy and/or can include in their daily routines, as such activities are more likely to be sustainable.”

In terms of nutrition, it is suggested that all individuals follow a healthy diet in order to prevent CVD. This should include whole grains, fruits, veggies, legumes, and nuts. The new suggestions include following the Mediterranean or similar diet; consuming no more than 100 g of alcohol each week (a regular drink comprises between 8 and 14 g); eating fish, preferably fatty, at least once a week; and avoiding meat, particularly processed meat.

In terms of body weight, it is recommended that overweight and obese individuals lose weight in order to reduce blood pressure, blood lipids, and diabetes risk, hence decreasing the risk of CVD. For the first time, the guidelines recommend that obese adults at high risk of cardiovascular disease consider bariatric surgery if good eating and exercise do not result in sustained weight loss.

Mental illnesses such as anxiety are connected with an elevated risk of cardiovascular disease (CVD) and a poor prognosis for those who have already been diagnosed with CVD. A new proposal is to provide enhanced support to individuals with these illnesses in order to increase compliance with lifestyle changes and medication treatment. Additionally, it is novel to consider referring patients with CVD and stress to psychotherapy stress management.

The guidelines advocate population-level initiatives to improve heart health and promote healthy lifestyle choices. These initiatives include those aimed at reducing air pollution, reducing reliance on fossil fuels, and limiting carbon dioxide emissions. Additional solutions include increased school playground area availability and legislation prohibiting the marketing of unhealthy food to children on television, the internet, social media, and food packaging. E-cigarettes, which are addictive, should be subject to the same marketing rules as conventional cigarettes, particularly those with flavours that appeal to minors. Caloric content and health warnings on alcohol labels may be considered.

As summarised by guidelines task force chairperson Professor François Mach of Geneva University Hospital, Switzerland, “CVD prevention requires an integrated, interdisciplinary approach that puts healthy people and patients at the centre and considers other health conditions, and environmental factors including air pollution.”

Image Credit: Getty

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