AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update - Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases
AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update - Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases
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DOI：
10.1161/01.cir.0000020190.45892.75
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发表时间：
2002-07-16
期刊：
影响因子：
37.8
通讯作者：
Taubert, KA
中科院分区：
文献类型：
--
作者：
Pearson, TA;Blair, SN;Taubert, KA
1997年出版了最初的《冠状动脉疾病一级预防指南》，以帮助医疗保健专业人员及其未患冠状动脉疾病或其他动脉粥样硬化疾病的患者。1旨在补充美国心脏协会（AHA）/美国心脏病学会（ACC）预防动脉粥样硬化性心血管疾病患者心脏病发作和死亡指南（更新2），并为医疗保健专业人员提供针对各种风险患者的综合方法。预防冠状动脉疾病或中风的首次发作或主动脉瘤和外周动脉疾病的发展的必要性仍然像以往一样强烈，因为致命或致残或需要昂贵的重症医学护理的首次事件的发生率仍然很高。越来越多的证据表明，大多数心血管疾病是可以预防的。长期前瞻性研究的结果一致地将具有低水平风险因素的人确定为具有终身低水平的心脏病和中风。3，4此外，这些低水平的风险因素与健康的生活方式有关。例如，来自护士健康研究的数据表明，在女性中，保持理想的体重，吃健康的饮食，经常锻炼，不吸烟，适量饮酒可以减少84%的风险，但只有3%的女性属于这一类。显然，大多数心血管疾病的原因是已知的和可改变的。2002年对《指南》的更新确认了1997年以来在初级预防领域取得的一些进展。研究继续完善关于检测和管理既定风险因素的建议，包括曾经被认为有希望的干预措施（如抗氧化维生素）的安全性和有效性的证据。6这反过来又刺激了大量针对特定人口统计学群体（如女性）、个体风险因素（如糖尿病、吸烟）和卒中一级预防的额外指南。在所有这些指南中，越来越强调根据风险水平对患者进行进一步分层，并将干预强度与心血管疾病事件的危害相匹配。7因此，2002年对《初级预防指南》的这一增订是为了纳入自最初的《指南》核准以来制定的其他准则和协商一致声明。本《指南》可被视为更具体、更详细的建议及其依据的切入点。因此，附表中列出的建议与以下建议一致：医疗保健政策和研究机构关于治疗烟草使用和依赖的指南8;预防、检测、评估和治疗高血压国家联合委员会的第六次报告（JNC VI）9; AHA膳食指南，修订版200010;美国心脏协会关于酒精和心脏病的声明11;国家胆固醇教育计划专家小组关于检测、评估和治疗成人高胆固醇的第三次报告12;美国心脏协会关于体育活动的科学声明和建议13、14和美国运动医学院指南15;《成人超重和肥胖症的识别、评估和治疗临床指南》美国心脏协会尽一切努力避免因外部关系或个人、专业或其他原因而可能产生的任何实际或潜在的利益冲突。
The initial Guide to the Primary Prevention of Cardiovas-cular Diseases was published in 1997 as an aid to healthcare professionals and their patients without established coronary artery disease or other atherosclerotic diseases. 1 It was intended to complement the American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines for Preventing Heart Attack and Death in Patients with Atherosclerotic Cardiovascular Disease (updated2) and to provide the healthcare professional with a comprehensive approach to patients across a wide spectrum of risk. The imperative to prevent the first episode of coronary disease or stroke or the development of aortic aneurysm and peripheral arterial disease remains as strong as ever because of the still-high rate of first events that are fatal or disabling or require expensive intensive medical care. The evidence that most cardiovascular disease is preventable continues to grow. Results of long-term prospective studies consistently identify persons with low levels of risk factors as having lifelong low levels of heart disease and stroke. 3, 4 Moreover, these low levels of risk factors are related to healthy lifestyles. Data from the Nurses Health Study, 5 for example, suggest that in women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, not smoking, and consuming a moderate amount of alcohol could account for an 84% reduction in risk, yet only 3% of the women studied were in that category. Clearly, the majority of the causes of cardiovascular disease are known and modifiable. This 2002 update of the Guide acknowledges a number of advances in the field of primary prevention since 1997. Research continues to refine the recommendations on detection and management of established risk factors, including evidence against the safety and efficacy of interventions once thought promising (eg, antioxidant vitamins). 6 This, in turn, has stimulated a large number of additional guidelines for specific demographic groups (eg, women), on individual risk factors (eg, diabetes, smoking), and for the primary prevention of stroke. In all of these guidelines, there is an increasing emphasis on further stratifying patients by level of risk and matching the intensity of interventions to the hazard for cardiovascular disease events. 7 Therefore, this 2002 update of the Primary Prevention Guide serves to integrate other guidelines and consensus statements developed since the initial Guide’s approval. This Guide might be viewed as the entry point to the more specific and detailed recommendations and the rationale behind them. The recommendations, as presented in the accompanying tables, are therefore consistent with the following recommendations: Agency for Healthcare Policy and Research Guidelines on Treating Tobacco Use and Dependence8; the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) 9; the AHA Dietary Guidelines, Revision 200010; the AHA Statement on Alcohol and Heart Disease11; the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults12; American Heart Association Scientific Statements and Advisories on Physical Activity13, 14 and the American College of Sports Medicine Guidelines15; the Clinical Guidelines for the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults from theThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or …