MONDAY, July 15, 2002 (HealthDayNews) --
Americans over 20 should be checked routinely for the tremors of potential heart trouble like high cholesterol, blood sugar trouble and high blood pressure.
That's the recommendation of the American Heart Association, which has updated its screening guidelines to reflect the growing understanding that while cardiovascular disease may be the leading killer of older Americans, its foundations are often laid in youth.
The association also recommends that all Americans over 40 learn their 10-year risk of heart and vessel disease, which causes heart attacks, strokes and other life-threatening ailments. And everyone should take steps to reduce these risks, by not smoking, exercising regularly, eating a low-fat diet and, if necessary, taking medications that can lower their cholesterol and blood pressure.
"We have to start preventing heart attacks in the first place rather than treating them after they've occurred," said Dr. Thomas Pearson, chief of cardiology at the University of Rochester Medical Center and chairman of the panel that drew up the guidelines.
While the risk of death from heart attack has dropped in the last decade, the rate of heart attacks appears to have remained unchanged, Pearson said. One reason is the rise in Type II diabetes, a significant cause of cardiovascular illness.
Heart disease claims approximately 950,000 lives a year in the United States, according to the Centers for Disease Control and Prevention. The agency estimates that 61 million Americans have some form of the condition, from high blood pressure to heart failure.
The new guidelines, which appear in tomorrow's issue of the journal Circulation, combine recent recommendations from other groups, including the American Diabetes Association and the U.S. Preventive Services Task Force, addressing risk factors for cardiovascular disease and how to prevent it.
Beginning at age 20, everyone should be evaluated for their risk of cardiovascular disease, the group said. That includes taking a family history to identify relatives who've suffered heart attacks and strokes, as well as a general lifestyle profile to assess things like smoking status, exercise habits and diet at every physical exam.
The heart group also calls on doctors to record blood pressure, pulse, body mass index and pattern of weight distribution at each office visit, or at least every two years. And blood fats and blood sugar content should be measured every five years in those without risk factors for heart disease and every two years for those with risk factors.
The guidelines also call for doctors to prepare a 10-year projection of the risk of heart disease at least every five years for people 40 and older. Elements of this equation can include total, "good" and "bad" cholesterol, age, sex, and the presence of diabetes. If a patient's risk factors change, the analysis should be conducted more frequently.
People with diabetes, or those whose 10-year risk of heart disease is greater than 20 percent, have the same risk of a heart attack or other adverse event as someone with a history of cardiovascular problems.
"You can have a little bit of high blood pressure, a little bit of high cholesterol, and a little bit of smoking and your risk can be as much as that of a patient who has had a heart attack," Pearson said.
Treatment recommendations include: Prescribing low-dose aspirin therapy to people considered at high risk of heart and vessel disease; and offering blood thinners to prevent strokes in those with atrial fibrillation, a faulty heart rhythm that can lead to blood clots in the brain.
Aspirin increases the risk of gastric and brain bleeding that can be serious and even fatal. But the guidelines state that the benefits of daily aspirin therapy exceed this potential harm for people with at least a 10 percent 10-year risk of cardiovascular trouble. Pearson said evidence suggests baby aspirin may be as effective as adult tablets yet carries fewer side effects.
Last year, an expert panel for the government recommended that as many as 36 million Americans may be candidates for cholesterol-lowering drugs called statins. These pills can significantly reduce the risk of heart attacks, strokes and other cardiovascular complications, and are considered widely underused.
Just as the American Heart Association is stressing the need to screen young people for cardiovascular disease, the cholesterol guidelines recommend testing for blood fat problems beginning at age 20, too.
Scientists have found that even young, otherwise healthy people with high cholesterol are at sharply higher risk of heart trouble as they age.
Reining in high cholesterol, either through drugs or changes in diet and exercise habits, can reduce the odds of heart attack and heart-related death by roughly 25 percent. Treatment also decreases the need for bypass surgery, angioplasty and other heart procedures, and lowers the risk of death from non-heart causes.
Dr. Larry Chinitz, a heart expert at New York University in Manhattan, said the latest guidelines won't be foreign to specialists.
But cardiologists typically don't see young patients until their heart problems are well-established; primary care doctors do. So the recommendations are intended to educate these physicians about how to detect and treat the earliest hints of cardiac illness before they start causing symptoms.
"If you could get a general doctor to know the guidelines and screen young patients, that would be a big change," Chinitz said.
What To Do
For more on cardiovascular disease, try the American Heart Association or the Centers for Disease Control and Prevention.
To find out more about cholesterol screening, check out the National Heart, Lung, and Blood Institute.
