NEW YORK (Reuters Health) - In recognition that most causes of cardiovascular disease are preventable, the American Heart Association (AHA) has released guidelines that advise doctors to routinely evaluate the risk of heart attack and stroke in patients as young as 20.

And when a patient turns 40, doctors should start calculating his or her estimated risk of developing cardiovascular disease within the next 10 years, a panel from the Dallas-based group advises. These so-called global risk estimates should be repeated at least every 5 years after age 40 and in younger patients with several cardiovascular risk factors, according to the guidelines, which have been updated since their original release in 1997.

"Heart disease is preventable and there is a tremendous amount that the individual patient could and should do to reduce their risk of heart attack," Dr. Thomas A. Pearson, of the University of Rochester in New York, told Reuters Health in an interview. Noting that deaths from heart disease have been declining but that the actual number of cases of heart disease have been on the rise, Pearson, who led the AHA panel that devised the

guidelines, said, "we've got to do a better job of preventing a first heart attack."

He noted that the guidelines place special emphasis on determining each individual's risk of heart disease and then taking steps to reduce the risks.

"Everyone should know what their risk is and talk with their physician about what they can do to reduce it," he said. "You and your physician need to form a partnership with the end goal of preventing your becoming a heart patient."

Pearson pointed out that the guidelines complement the guidelines for people who already have heart disease, which the AHA updated last year. The current guidelines are published in the online edition of Circulation: Journal of the American Heart Association.

According to Pearson and his colleagues, adopting a healthy lifestyle is the "cornerstone" of the effort to prevent heart attacks and strokes in people who do not have cardiovascular disease. The panel advises patients not to smoke, avoid secondhand smoke, eat a healthy diet, keep weight under control and get at least 30 minutes of moderate exercise on most, if not all, days.

The panel also recommends that most people strive to keep blood pressure below 140/90 millimeters of mercury (mm Hg), and that people with kidney disease, heart failure or diabetes seek to lower it even further.

For people with no more than one cardiovascular risk factor, levels of LDL, the "bad" form of cholesterol, should be kept under 160 milligrams per deciliter of blood (mg/dL), according to the guidelines. The goal should be lower for people at higher risk.

The panel has updated the guidelines for the use of aspirin to prevent heart attack and stroke, which had previously been recommended mainly for people who have already had a heart attack or stroke. People with a higher risk of cardiovascular disease are advised to take a low dose--75 mg to 160 mg--of aspirin each day. This is the equivalent of one or two baby aspirins. In people at increased risk of heart attack or stroke, the cardiovascular benefits of aspirin outweigh the risk of side effects, including gastrointestinal bleeding and bleeding in the brain, according to Pearson.

In another change, the panel recommends that patients with an irregular heart rhythm called atrial fibrillation take blood thinners to reduce the risk of stroke.

SOURCE: Circulation 2002;10.1161/01.CIR.0000020190.45892.75.

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