Prevention of Cardiovascular Diseases

Chapter: Prevention of Cardiovascular Diseases
McMaster Section Editor(s): P.J. Devereaux
Section Editor(s) in Interna Szczeklika: Andrzej Budaj, Wiktoria Leśniak
McMaster Author(s): Mirna Attalla, Greg Curnew
Author(s) in Interna Szczeklika: Barbara Cybulska, Longina Kłosiewicz-Latoszek, Wiktor Szostak
Additional Information

DefinitionTop

Cardiovascular disease (CVD) prevention is based on the assessment or identification and modification or elimination of cardiovascular risk factors.

Modifiable cardiovascular risk factors:

1) Atherogenic diet.

2) Smoking.

3) Physical inactivity.

4) High blood pressure.

5) Dyslipidemia: Elevated serum low-density lipoprotein cholesterol (LDL–C) levels, low high-density lipoprotein cholesterol (HDL-C) levels, elevated triglyceride (TG) levels.

6) Impaired glucose tolerance or diabetes mellitus.

7) High body mass index (BMI).

Nonmodifiable cardiovascular risk factors:

1) Age (men ≥45 years, women ≥55 years).

2) Family history of early (<55 years in men and <65 years in women) ischemic heart disease (IHD) or atherosclerosis of other arteries.

3) Chronic kidney disease (CKD).

4) Chronic inflammatory disease (eg, systemic lupus erythematosus, rheumatoid arthritis).

5) Ethnicity (eg, South Asian).

6) Menopause at an age <40 years.

7) History of preeclampsia.

Risk AssessmentTop

The frequency of cardiovascular risk assessment should depend on the degree of risk and presence of borderline indications for treatment. It should be performed at least every 5 years.

In persons with no additional risk factors (such as CVD, diabetes mellitus, CKD, or a markedly expressed individual risk factor), the 10-year CVD risk assessment can be calculated using the Framingham risk score, which takes into account age, sex, systolic blood pressure (treated or untreated), HDL-C, and smoking status (Table 3.15-1). Of note, there are many modifications of this risk score, some taking into account BMI or diabetes; see the official website of the Framingham Heart Study.

PreventionTop

Prevention goals based on the Canadian Cardiovascular Society guidelines:

1) Nonsmoking status.

2) Healthy diet (minimizing intake of processed food, refined carbohydrates, trans fats, and unsaturated fats).

3) Physical activity reduces individual risk factors for cardiovascular disease; however, the absolute effect of physical activity on reducing the risk of developing CVD remains unclear.

4) Body weight reduction: Optimally maintain BMI within 20 to 25 kg/m2 and waist circumference <94 cm in men and <80 cm in women. Recommend weight loss if waist circumference is >102 cm in men and >88 cm in women.

5) Blood pressure <140/90 mm Hg for all patients, possibly <130 mm Hg in those who tolerate treatment well. In patients with diabetes a target systolic blood pressure <130 and diastolic blood pressure <80 mm Hg is currently provided in clinical practice guidelines, including Hypertension Canada guidelines.

6) LDL-C levels depending on the risk category (see Table 3.12-1).

7) Glycated hemoglobin (HbA1c) <7% in patients with type 2 diabetes. A less strict target can be used in frail patients and those at higher risk for developing hypoglycemia. A target of <6.5% has been recommended for patients with diabetic microvascular complications.

8) Secondary prevention: Note that similar treatment goals occur in the presence of certain clinical conditions (secondary prevention): atherosclerosis; abdominal aortic aneurysm; diabetes mellitus at an age >40 years (type 1 diabetes at an age >30 years), of >15 years’ duration, or with microvascular disease; CKD at an age >50 years (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 or albumin-to-creatinine ratio [ACR] >3 mg/mmol), LDL-C >5.0 mmol/L. Atherosclerosis is defined as acute coronary syndrome, stable angina, angiographically documented CAD, stroke, transient ischemic attack, or carotid or peripheral vascular disease. Patients with acute coronary syndrome within the last 3 months have lower treatment targets for LCD-C (1.8 mmol/L; see Table 3.12-1).

Tables Top

Table 3.15-1. Framingham risk score: estimation of the 10-year risk of cardiovascular disease

Risk factor

Risk points

Men

Women

Age

35-39

2

2

40-44

5

4

45-49

7

5

50-54

8

7

55-59

10

8

60-64

11

9

65-69

12

10

70-74

14

11

≥75

15

12

HDL-C (mmol/L)

>1.60

−2

1.30-1.60

−1

1.20-1.29

0

0.90-1.19

1

<0.90

2

Total cholesterol (mmol/L)

4.10-5.19

1

1

5.20-6.19

2

3

6.20-7.20

3

4

>7.20

4

5

Systolic blood pressure (mm Hg)

 

Untreated

Treated

Untreated

Treated

<120

−2

0

−3

−1

 120-129

0

2

0

2

 130-139

1

3

1

3

 140-149

2

4

2

5

 150-159

2

4

2

5

>160

3

5

5

7

Smoking status

Smoker

4

3

Interpretation

10-year risk of CVD is assumed to be:

High if risk is ≥20%;

Intermediate if risk is 10%-19%;

Low if risk is <10%.

For women:

High risk: ≥18 points

Intermediate risk: 13-17 points

For men:

High risk: ≥15 points

Intermediate risk: 11-14 points

Based on Circulation. 1998;97(18):1837-47 and Can J Cardiol. 2016;32(11):1263-1282.

CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol.

We would love to hear from you

  • Do you have any comments?
  • Have you found a mistake?
  • Would you like to suggest a feature?

We use cookies to ensure you get the best browsing experience on our website. Refer to our Cookies Information and Privacy Policy for more details.