Reducing the risk of heart attack and stroke: the American Heart Association/American College of Cardiology prevention guidelines.

Abstract

A 58-year-old man, JB, schedules a visit with his primary care physician to explore what he could do to prevent a heart attack or stroke. He previously considered himself in good health and is not aware of any medical problems or symptoms. His visit is prompted by his best friend having a heart attack and the recollection that his father suffered a massive heart attack at age 59. JB continues to smoke ≈10 cigarettes a day. He plays an occasional game of pick-up basketball with friends but has a sedentary job. Over the past 20 years, he acknowledges that he has accumulated ≈25 pounds of excess weight. JB cautions his physician that he does not want to take a lot of pills, but is not clear how best to improve his chances of avoiding his father’s fate. On physical examination, JB’s weight is 230 pounds, height 72 inches, corresponding to a body mass index of 31.2 kg/m2, classified as obese. His blood pressure is 160/95 mm Hg, heart rate 78 beat/min and regular. Apart from his truncal obesity, the remainder of his physical examination is normal. His physician orders blood work, a cholesterol panel, and a blood sugar. After the results are available, he begins a discussion with JB. Approximately every 34 seconds, someone in the US has a heart attack. Research has shown that there are major risk factors which significantly increase the risk of angina pectoris, heart attack, stroke, and sudden cardiac death—all part of the cardiovascular disease (CVD) spectrum. The modifiable risk factors—factors that can be influenced by healthy behaviors—include hypertension, smoking, elevated blood cholesterol (lipids), and diabetes mellitus. The more risk factors a person has, the greater the chances of developing some form of CVD. Also, the greater the level of each risk factor, …