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Heart Attack Prevention Should Start Early in Life - 2002-07-17

A strong heart requires a healthy lifestyle from early adulthood. That is the main message from a new series of guidelines to prevent heart disease and stroke issued by the American Heart Association. The organization has modified its previous recommendations to stress that steps to prevent heart disease should not wait until middle age.

Within one year of having a heart attack, half of the victims die. Similarly, stroke kills one of six of the people it hits. The two illnesses combined account for more than half of all deaths worldwide.

With the aim of cutting this toll, the American Heart Association has updated its 1997 guidelines for heart disease and stroke prevention.

The update emphasizes that prevention should start early in life, with routine checks of blood pressure, blood sugar, and cholesterol. The previous guidelines did not specify an age, but the head of the association's Council on Nutrition, Physical Activity, and Metabolism, Robert Eckel, says the revised rules set it at 20.

"The age of 20 is the time in which people have reached their adult years and it's time where steps in prevention may be particularly important in reducing the incidence of heart disease and stroke that begins to occur in the thirties in men and forties in women," he said.

The heart association is promoting the trend toward even earlier screening because of the increase in child and adolescent obesity, a major risk factor for heart disease.

"The group of us are working on guidelines that would be specifically applied to pediatric population," said Dr. Stephen Daniels who specializes in young hearts at the Children's Hospital Medical Center in Cincinnati, Ohio. "So we are in the process of working on these guidelines and hope to see them published in the next six months or so."

The new guidelines maintain the American Heart Association's longstanding advice to eat a low fat diet rich in fruit and vegetables, to perform moderate exercise at least 30 minutes daily, and to avoid smoking.

But the principle author, University of Rochester, New York medical professor Thomas Pearson, says they now advocate avoiding the tobacco smoke of others.

"We have garnered considerable evidence to suggest that it is not just active smoking but actually exposure to environmental tobacco smoke, which is an important cause of heart disease," he said. "So that now not only should a person not smoke, but also clean up the environment either at home or at work."

The old guidelines recommended small daily doses of aspirin for people who had already suffered a heart attack. Aspirin helps prevent blood clots. The updated rules advocate this for anyone with more than a 10 percent chance for a heart attack in the next decade, regardless of whether they have had one or not. This includes individuals who are overweight, smoke, have high blood pressure or diabetes, or have a family history of heart disease.

Dr. Pearson says the guidelines are important because few people know that these factors promote heart problems.

"We know, for example, that only 50 percent of people are tested for diabetes, only about 50 to 60 percent of people know what their blood pressure is, only 50 to 60 percent of people have had their cholesterol measured," he said.

The American Heart Association made its updated guidelines easier to follow in the hope that more people could understand them. For example, for measuring obesity, it adds a simple waistline measure to the more technical body mass index. Men should have a waistline of no more than 100 centimeters, and women, 90 centimeters.

"Unequivocally, these recommendations can be applied across the world," said Dr. Robert Eckel. "The steps for prevention I think are well based and certainly as applicable in Finland as they are in Brazil."