Recommendations for maintaining and improving heart, brain and artery health

Over the long term, cardiovascular risk factors contribute to the development of cardiovascular diseases and atherosclerosis. Some of these risk factors cannot be modified, but others can, which delays the onset of cardiovascular diseases. These illnesses are the principal cause of death and disability in our continent. Healthy lifestyle changes can lead to great benefits, especially if commenced during childhood.

Age, heredity and gender are unmodifiable risk factors. In men, the risk of cardiovascular disease appears at earlier ages than in women, although these illnesses are highly prevalent in women, who often underestimate their personal risk. Having close family members, parents or siblings who have had some type of coronary disease, in the arteries of the leg, aorta or its branches, or of the cerebral arteries raises one's individual risk, requiring medical attention at younger ages.
The modifiable risk factors are: tobacco use and exposure to tobacco smoke; high blood pressure, high cholesterol, physical inactivity, overweight and obesity. Diabetes also increases cardiovascular risk.

Recommendations for risk reduction

Tobacco: Stop using tobacco completely and avoid exposure to other people's smoke.

High blood pressure: The desired blood pressure level is 120/80 (12/8) mm Hg or less; high blood pressure is 140/90 (14/9) mm Hg or higher. Lifestyle modifications help control blood pressure: weight loss, reduced salt consumption, regular consumption of fruit, vegetables and low-fat dairy products, moderate or no alcohol consumption and regular physical activity.

Lipids: The desired level of total cholesterol is below 200 mg/dL, above all for people with cardiovascular disease or other risk factors. For lipid control, a balanced diet is recommended, with at least 5 daily servings of fruit and vegetables; along with whole grains; non-fat or low-fat dairy products, fish, legumes, poultry and lean red meat.

Alcohol: If you drink, limit alcohol consumption to less than 2 drinks a day if you're a man and less than 1 drink if you're a woman.

Physical activity: At least 30 minutes of daily moderate physical activity (walking, bicycling, stairclimbing, etc) is recommended, on most or preferably all days of the week.

Overweight and obesity: In addition to total weight and body mass index (BMI= weight / height², we should also be aware of waist circumference. In men, waist circumference should be less than 102 cm (below 92 cm is ideal) and in women, less than 88 cm (below 80 cm is ideal). The desired BMI is less than 24.9; 25 to 29.9 is considered overweight and more than 30 is considered obese. Weight-loss programs should be based on a reduction of calorie intake and increased physical activity.

Diabetes: Fasting blood glucose should be below 110 mg/dL, and ideally, lower than 100 mg/dL. A reading above 126 mg/dL on two occasions is considered diabetes. The first option for normalizing blood glucose is to maintain a healthy diet and get regular physical activity. If your doctor recommends pharmaceutical treatment, this should always be accompanied by intensive treatment of any other risk factors.

Medication use for prevention: Very often, to treat risk factors like high blood pressure, high cholesterol, diabetes, etc., your doctor Hill recommend a medication along with changes in lifestyle. There are also effective medications to help smokers quit.

Aspirin: Aspirin (acetylsalicylic acid), taken in low daily doses (between 75 and 160 mg) by people with two or more risk factors or who have experienced a cardiovascular event, helps reduce risk. If there are no contraindications, the InterAmerican Heart Foundation recommends daily use of aspirin for patients with myocardial infarction (heart attack), unstable angina, ischemic stroke or transient ischemic attack (tIA).

For people who have not had these cardiovascular problems, this decision should be made with the advice of a doctor.

Aspirin in low doses for heart disease prevention in women should be considered in some circumstances. It is recommended for women with high cardiovascular risk (with two or more risk factors, especially those older than age 65. It is not recommended for young, premenopausal women with low cardiovascular risk. In intermediate-risk women, the recommendation can vary based on other conditions; it is best to consult a doctor.

The InterAmerican Heart Foundation has a guide for aspirin use in Latin America, which recommends caution in regions with endemic infectious diseases such as Dengue fever.

Framingham scores for 10-year risk estimate

Baaed on Framingham Study data, a point system was created for the evaluation of an individual's % cardiovascular risk, or in other words, the probability of having a cardiac event or stroke in the next 10 years. Add up the points in the table below to evaluate your risk.

Example: A 47-year-old man with cholesterol of 210 mg/dL, smoker, with HDL-C (good cholesterol) of 45 mg/dL and treated systolic blood pressure of 130mm Hg, has a score of 3 for age, 5 for cholesterol, 5 for smoking, 1 for HDL-C, and 2 for blood pressure: The total is 16 points, which indicates a 25% probability of a cardiac event or stroke in the next 10 years.