Primary prevention
The most important preventive actions involve combined dietary and lifestyle modifications (stopping smoking; increasing physical activity; losing weight; increasing consumption of fish, fruits, vegetables, fiber, and nuts; reducing salt intake).[32]
Smoking is a leading preventable cause of disease, disability, and death; even low levels of smoking increase risk of atherosclerotic cardiovascular disease (ASCVD).[32][51] Support programs, medications, and alternative therapies are available. In adults who use tobacco, a combination of behavioral interventions plus pharmacotherapy is recommended.[32] Secondhand smoke exposure should be avoided.[32]
Routine and/or opportunistic assessment of cardiovascular risk factors with calculation of 10-year risk of ASCVD should be used to guide decisions on treatment with preventive therapies (e.g., statins).[32][52] [ ASCVD Risk Estimator Plus Opens in new window ]
The US Preventive Services Task Force recommends that adults ages 40 to 75 years without ASCVD but who have one or more cardiovascular risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year cardiovascular disease risk of 10% or greater should be started on a statin for primary prevention. Those with 10-year risk of between 7.5% and 10% may selectively be offered a statin. For patients 76 years or older there is insufficient evidence to recommend for or against starting a statin for primary prevention.[53]
Aspirin is no longer routinely recommended for primary prevention but may be considered in selected patients for whom the absolute cardiovascular benefit outweighs the absolute risk of increased bleeding.[54]
Secondary prevention
The most important preventive actions involve combined dietary and lifestyle changes (stopping smoking; increasing physical activity; losing weight; increasing consumption of fish, fruits, vegetables, fiber, and nuts; reducing salt intake).
Patients should switch to a heart-healthy diet. If overweight, patients should lose weight and maintain a healthy body weight. Patients should consume a diet rich in vegetables and fruits. Patients should be advised to choose wholegrain, high-fiber foods and to eat fish, especially oily fish, at least twice a week. Excess sugars, trans-fats, salt, and foods with excess cholesterol should be limited.
For a smoker, cessation is the single most crucial step that can be taken to reduce heart-related and all-cause death. This includes avoiding second-hand smoke. Many different support programs, medications, and alternative therapies are available to help. Data from the EVITA (Evaluation of Varenicline in Smoking Cessation for patients post Acute Coronary Syndrome) trial suggest that pharmacotherapy with varenicline started in hospital at the time of an acute coronary syndrome may be efficacious for smoking cessation; however, further studies to assess safety endpoints are needed.[154] It takes as little as 3 years of smoking cessation in a smoker who has had a myocardial infarction to reduce risk from cardiac death to the same level as that for someone who has never smoked.
Improving physical fitness through aerobic exercise is extremely important. It is recommended that patients engage in ≥30 minutes of moderate-intensity physical activity on most, and preferably all, days of the week. Likewise, patients should engage in multiple short bouts of physical activity daily, such as walking the dog or taking the stairs instead of the elevator.
Family members can be very helpful and should become involved along with other support systems to help remind patients of, and to reinforce, lifestyle changes. Patients should use the resources that are available (e.g., written materials, the Internet, educational classes, regular counseling) and be in close communication with healthcare providers.
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