U.S. Experts Issue New Heart Disease Treatment Guidelines

Among the changes: a lower recommended dose of daily aspirin, and more exercise

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By Ed Edelson
HealthDay Reporter

MONDAY, May 15, 2006 (HealthDay News) -- America's top experts in heart disease have issued new guidelines on helping people with the illness avoid more cardiovascular trouble.

The guidelines, issued Monday by the American Heart Association and the American College of Cardiology, apply to a wide range of patients: Those who have had heart attacks, those with the variety of heart problems called acute coronary syndromes, and those with other blood vessel conditions such as peripheral arterial disease.

The recommendations were issued in a joint statement by the two organizations and have also been endorsed by the National Heart, Lung, and Blood Institute.

The new guidelines come as the result "of a number of new trials completed since our last recommendations were issued," said Dr. Sidney S. Smith, a professor of medicine at the University of North Carolina and chairman of the group that drew up the report.

Some recommendations in the guidelines, which update those issued five years ago, are new. For example, the new rules advise that anyone with heart disease get a flu shot every year.

Other recommendations simply highlight tried-and-true means of reining in risk.

One advisory: people diagnosed with heart disease should get 30 to 60 minutes of moderate exercise, such as brisk walking, at least five, and preferably seven, days a week. The old guidelines called for this type of exercise three or four days a week.

The old guidelines held that blood levels of LDL cholesterol, the bad kind that clogs arteries, should stay below 100 milligrams per deciliter (mg/dL) and, ideally, below 70 mg/dL for very high-risk patients. According to the new advisory, those guidelines are now recommended for all people with established heart disease.

Levels of all blood fats, excluding HDL cholesterol -- the good kind that helps keep arteries clear -- should be kept under 100 milligrams per deciliters, the new guidelines say.

Some guidelines are unchanged. Blood pressure still should be no more than 140 over 90 for most patients, and less than 130 over 80 for people with diabetes or chronic kidney disease

As for weight, the recommended body mass index (BMI) is between 18.5 to 24.8, with waist circumference less than 40 inches for men and less than 35 inches for women (for reference, statistical obesity starts at a BMI of 30).

For diabetes management, a test for blood sugar levels is recommended every two to three months, with the desired level kept to less than 7 percent.

The recommended dosage of aspirin for patients with heart disease or other blood vessel problems such as peripheral arterial disease has been lowered. It should now be between 75 and 162 milligrams a day, the new guidelines say -- the old rule allowed daily amounts as high as 325 milligrams. Studies have shown that the lower dose provides all the benefits without the risk of bleeding associated with higher amounts, Smith said.

Both organizations will mount campaigns to have cardiologists and other physicians begin to apply the recommendations, Smith said.

"Intensive use of these therapies really can have major benefits in reducing future heart attacks, the need for revascularization [blood vessel reopening] and stroke, and generally patients are not receiving them," he said. "That trend has just got to be stopped if were going to make progress."

More information

Find out more about heart disease risk factors at the American Heart Association.

SOURCES: Sidney C. Smith, M.D., professor, medicine, University of North Carolina, Chapel Hill; May 13, 2006, joint statement, American Heart Association/American College of Cardiology

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