We offer an updated and concise clinician's guide to the ABCDEs based on updated guidelines and recent evidence for practical use in a practice setting. Subsequent to the 2004 update of ATP III, 2 additional trials8,9 demonstrated cardiovascular benefit for lipid lowering significantly below current cholesterol goal levels for those with chronic CHD. Finally, recently published findings of a trial involving angiotensin-converting enzyme inhibitor therapy among patients at relatively low risk with stable coronary disease and normal left ventricular function influenced the recommendations.26, The writing group has for the first time added a recommendation with regard to influenza vaccination. Combination therapy with both aspirin 75 to 162 mg daily and clopidogrel 75 mg daily may be considered in patients with stable coronary artery disease. Copies: This document is available on the World Wide Web site of the American Heart Association (my.americanheart.org). Finally, to avoid any misunderstanding about cholesterol management in general, it must be emphasized that a reasonable cholesterol level of <70 mg/dL does not apply to other types of lower-risk individuals who do not have CHD or other forms of atherosclerotic disease; in such cases, recommendations contained in the 2004 ATP III update still pertain. Reduce the “salty six:” breads/rolls, canned soups, cold cuts/cured meats, pizza, poultry with added sodium such as pre-seasoned fillets and chicken nuggets, and burgers from fast-food restaurants. For patients undergoing coronary artery bypass grafting, aspirin should be started within 6 hours after surgery to reduce saphenous vein graft closure. 7272 Greenville Ave. 1. Initiation of pharmacotherapy interventions to achieve target HbA1c may be reasonable. Recommend addition of two days of resistance training [Class IIa]. Lifestyle interventions are the first-line followed by antihyperglycemics [Class I]. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce mortality.). Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, CardioSource Plus for Institutions and Practices, Nuclear Cardiology and Cardiac CT Meeting on Demand, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). 1. A comprehensive exercise-based outpatient cardiac rehabilitation program can be safe and beneficial for clinically stable outpatients with a history of heart failure. Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Sports and Exercise Cardiology, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Homozygous Familial Hypercholesterolemia, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Acute Heart Failure, Interventions and Vascular Medicine, Diet, Exercise, Hypertension, Sleep Apnea, Keywords: Dyslipidemias, Adenosine, Anticoagulants, Antihypertensive Agents, Aspirin, Atherosclerosis, Atrial Fibrillation, Benzhydryl Compounds, Blood Glucose, Blood Pressure, Body Mass Index, Brain Ischemia, Bupropion, Caloric Restriction, Cardiac Rehabilitation, Cardiovascular Diseases, Cause of Death, Centers for Disease Control and Prevention (U.S.), Cholesterol, Cohort Studies, Coronary Vessels, Creatinine, Diabetes Mellitus, Type 2, Diabetes, Gestational, Diet, Diuretics, Drug-Eluting Stents, Factor V, Fasting, Fibric Acids, Follow-Up Studies, Gingiva, Glucose, Glucosides, Hemoglobin A, Glycosylated, Goals, Heart Diseases, Heart Failure, HIV Infections, Hydralazine, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypercholesterolemia, Hyperlipoproteinemia Type II, Hypertension, Hypertension, Pregnancy-Induced, Hypoglycemic Agents, Insulin, Life Style, Lipids, Medication Adherence, Metformin, Mineralocorticoid Receptor Antagonists, Myocardial Infarction, Nebulizers and Vaporizers, Nicotine, Nutritionists, Obesity, Overweight, Patient Participation, Polycystic Ovary Syndrome, Percutaneous Coronary Intervention, Pre-Eclampsia, Primary Prevention, Registries, Resistance Training, Risk Factors, Secondary Prevention, Sleep Apnea Syndromes, Smoke, Stroke, Stroke Volume, Ticlopidine, Tobacco, Tobacco Use, Tobacco Use Cessation, Triglycerides, Waist Circumference, Warfarin, Water-Electrolyte Balance, Weight Loss. 2. This article has been copublished in the May 16, 2006, issue of the Journal of the American College of Cardiology (J Am Coll Cardiol. • Further reduction of non-HDL-C to <100 mg/dL is reasonable. Clinician's guide to the updated ABCs of cardiovascular disease prevention. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction ≤40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. 1. 1. Complete cessation. Counsel to avoid exposure to environment to tobacco smoke (e.g., work environment, second-hand exposure) [Class I]. Additional searches cross-referenced these topics with the subtopics of clinical trials, secondary prevention, atherosclerosis, and coronary/cerebral/peripheral artery disease. In this regard, it is important that the healthcare provider not only implement the therapies according to their class of recommendation but also assess for and assist with patient compliance with these therapies in each patient encounter. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Goal waist circumference (measured at the level of the iliac crest) is <40“ (94 cm) for men and <35“ (80 cm) for women [Class I]; smaller waist circumference targets for South Asians, Chinese, Japanese would be appropriate.
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