News Release

Guidelines to reduce heart attacks in cardiovascular patients updated

Peer-Reviewed Publication

American Heart Association

DALLAS, Sept. 25 – New guidelines aimed at preventing heart attacks in people who have already had a heart attack, or other forms of cardiovascular disease, urge wider use of beta-blockers and ACE-inhibitors for heart attack survivors and more aggressive control of risk factors.

Compelling evidence from recent clinical trials prompted the American Heart Association and the American College of Cardiology (ACC) to update guidelines on preventing heart attacks among those with existing cardiovascular disease. The updated secondary prevention guidelines, revised from ones issued in 1995, are published in today’s Circulation: Journal of the American Heart Association. An estimated 12.4 million Americans have been diagnosed with cardiovascular disease.

"Aggressive risk-factor management clearly improves patient survival, reduces the recurrence of heart attacks, strokes and the need for procedures to restore blood flow to the heart, and improves the quality of life of patients," says Sidney C. Smith, M.D., chief science officer of the American Heart Association, who chaired the committee that wrote the update.

The guidelines incorporate findings from several major heart disease studies completed since the original guidelines were published, including the discovery that hormone replacement therapy is ineffective in preventing heart attacks in women with cardiovascular disease, and the significant value of cholesterol lowering. They also include recent cholesterol recommendations from the National Heart, Lung and Blood Institute and diabetes risk factor management recommendations from the American Diabetes Association.

The new guidelines recommend treating all heart attack survivors indefinitely with drugs called ACE inhibitors, which have been shown to reduce death in such patients. They also recommend giving beta-blocker drugs to heart attack survivors and individuals whose hearts are getting an inadequate blood supply. As with the previous guidelines, smoking cessation is encouraged, but the revisions also recommend avoiding secondhand smoke as well. Eating foods high in omega-3 fatty acids, and the use of newer antiplatelet agents for patients unable to take aspirin to reduce the risk of blood clots are also among the new recommendations.

These joint guidelines have gained increasing importance since they were first published because of two factors: The aging of the American population continues to increase the number of Americans with cardiovascular disease and the surge in the incidence of diabetes has put even more people at risk.

"There is an increased incidence and prevalence of heart attacks, heart disease, and stroke in general in the older population," says Noel Bairey Merz, MD, chair of the ACC’s prevention committee and director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles. "We need to be very aggressive in our prevention efforts in older people who have cardiovascular disease."

"Diabetes is also very important in terms of its impact on cardiovascular disease," adds Smith, a professor of medicine and director of the Center for Cardiovascular Science in Medicine at the University of North Carolina at Chapel Hill. "Two-thirds of deaths in diabetic patients are from cardiovascular disease, and the growth of type 2 [adult-onset] diabetes is staggering in its proportion. The potential benefits that we might realize by tightening the control of diabetes, in terms of reducing the toll of heart disease and stroke, are enormous."

In spite of the proven benefits, many studies on the use of preventive reveal that a large number of patients eligible for them are not receiving them.

The American Heart Association recently launched a project called Get With The GuidelinesSM to encourage hospitals to treat patients using these updated guidelines and to provide tools and training to help hospitals translate what is known about preventing recurrent cardiovascular events into commonplace practice.

"Using the guidelines can make a difference by preventing future heart attacks, and improving patients’ quality of life," says Smith. "Far too often patients don’t get all the recommended treatments, even for something as common as a heart attack. For example, a meager one-third of eligible heart attack patients in the United States are prescribed cholesterol-lowering drugs before hospital discharge, despite the widely documented benefits. Tens of thousands of lives could be saved if these guidelines were thoroughly implemented on a national basis."

The guidelines will also be published in the November issue of Journal of the American College of Cardiology.

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Co-authors are Steven N. Blair, P.E.D.; Robert O. Bonow, M.D.; Lawrence M. Brass, M.D.; Manuel D. Cerqueira, M.D.; Kathleen Dracup, R.N., D.N.Sc.; Valentin Fuster, M.D., Ph.D.; Antonio Gotto, M.D.; D. Phil.; Scott M. Grundy, M.D. Ph.D.; Nancy Houston Miller, R.N., B.S.N.; Alice Jacobs, M.D.; Daniel Jones, M.D.; Ronald M. Krauss, M.D.; Lori Mosca, M.D., Ph.D.; Ira Ockane, M.D.; Richard C. Pasternak, M.D.; Thomas Pearson, M.D., Ph.D.; Marc A. Pfeffer, M.D., Ph.D.; Rodman D. Starke, M.D.; and Kathryn A. Taubert, Ph.D.

CONTACT: For journal copies only, please call: (214) 706-1396

For other information, call:
Carole Bullock: (214) 706-1279
Bridgette McNeill: (214) 706-1135
Katherine Doerman, ACC: (301) 897-2628


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