In an update to its 1997 recommendations, the American Heart Association has issued new guidelines aimed at preventing heart disease and stroke. As evidence continues to show that cardiovascular disease, the leading cause of death in the US, is preventable and that risk factors can be minimized through lifestyle modifications, renewed emphasis is being placed on early detection and management of known risk factors.

Specifically, the guidelines recommend that adults begin risk factor screening as early as age 20 and, by age 40, should know their absolute risk of developing heart disease. Risk factor assessment should include: 

• Family history – update regularly 
• Smoking status – at every routine evaluation 
• Diet – at every routine evaluation 
• Level of alcohol intake – at every routine evaluation 
• Level of physical activity – at every routine evaluation 
• Blood pressure – at each visit, at least every 2 years 
• Body mass index – at each visit, at least every 2 years 
• Waist circumference – at each visit, at least every 2 years 
• Pulse – at each visit, at least every 2 years 
• Fasting serum lipoprotein or total and HDL cholesterol – at least every 5 years, every 2 years if risk factors are present 
• Fasting blood glucose – at least every 5 years, every 2 years if risk factors are present (diabetes is a risk factor for heart disease)

In addition, adults 40 years of age and older or with 2 or more risk factors should have their 10-year risk estimated with a multiple risk score every 5 years. There are charts and formulas already available for physicians to use to estimate a patient’s risk of heart disease and stroke.

The 2002 update incorporates guidelines and statements that have been developed by other health care organizations since 1997, including the Agency for Healthcare Policy and Research, the National Heart, Lung, and Blood Institute, and the US Preventive Services Task Force. Its purpose is to aid physicians in the assessment, management, and follow-up of adult patients who may be at risk for but who do not currently have heart disease. The goal is to reinforce the message about adopting a healthy lifestyle sooner rather than later, when preventive measures can have a positive impact.

While the guidelines provide a wealth of information for doctors, including specifics of what interventions and goals they should recommend to patients and parameters for weight, cholesterol, and blood glucose levels, there is only so much the doctors themselves can do. The crucial element to a successful prevention plan is the patient. In light of the AHA’s position, it is hoped that people will recognize the benefits and take the initiative to make an appointment with their physicians to be screened for cardiovascular disease as the first step to better health and possibly a longer life.