Statement 1

From the Clinical Practice Guidelines for the Management of Dyslipidemia by the Philippine Heart Association
This guideline starts below.

Statement 1

To reduce the overall cardiovascular risk, all patients, regardless of their present morbid condition or risk profile, should be advised on the need for the following:

• Smoking cessation
• Weight management
• Regular physical activity
• Adequate blood pressure monitoring and control

Smoking

Cigarette smoking increases coronary vascular disease risk in both men and women in a dose-dependent manner. It approximately doubles coronary heart disease (CHD) risk, which may further increase with the number of cigarettes smoked. Conversely, smoking cessation in the primary prevention settings substantially reduces cardiac risk within months after quitting. Hence, smoking cessation is consistently included in CVD risk management. For significant CV risk reduction, the goal is complete smoking cessation and avoidance of passive smoking. The physician's advice is the crucial first step.

Weight management

Adiposity is associated with CVD, as well as stroke and numerous other co-morbid conditions. It is also associated with higher all-cause mortality, largely because of an increase in CVD mortality. In addition, people who are overweight or obese have a high burden of other CHD risk factors, including dyslipidemia. Meanwhile, reducing weight reduces blood pressure, plasma LDL and triglyceride levels, increases HDL levels and decreases glucose intolerance.

Although BMI is the most widely used measure of adiposity, abdominal obesity is more strongly correlated with CV risk. The goals and approaches to abdominal obesity may vary with geographic region. Abdominal obesity may be measured using the ratio of waist to hip circumference (WHR). In Caucasians, a WHR greater than 1.0 for men and greater than 0.85 for women indicates abdominal fat accumulation. However, according to the Asia-Pacific Perspective: Redefining Obesity and Its Treatment, the waist circumference is the preferred measure of abdominal obesity compared to the WHR, and may be sued to quality a patient's risk of associated co-morbidities such as diabetes, metabolic syndrome, CHD, sleep apnea and osteoarthritis.

Physical activity

Regular physical activity is associated with a lower risk of death from CVD and CHR, but the mechanisms behind this are not fully understood and probably multi-factorial. Physical activity is associated with lower levels of LDL and triglycerides, higher HDL cholesterol, improved insulin sensitivity and lower blood pressure. Moreover, exercise-based cardiac rehabilitation in patients with established CAD has been shown to reduce total CV mortality.

For physical activity to be protective, it must be vigorous, aerobic, habitual and continuing. A large-scale study suggests that 3 hours a week of moderately vigorous activity or activity equivalent to 3,500 kilocalories is protective. However, this study was done in Caucasians and there are no current local data on this matter.

Moderately vigorous activity includes swimming, basketball, volleyball, badminton, tennis, jogging and running. The equivalent of 3,500 kilocalories is walking 35 miles (56 km) or climbing 438 flights of stairs (20 steps/flight).

Blood pressure

Hypertension should be a concern in dyslipidemic patients because it commonly occurs concomitantly with hypercholesterolemia. Particular after MI, treatment of hypertension, including regimens with beta-blockers or angiotensin-converting enzyme inhibitors, reduces recurrent MI and all-cause mortality, as well as fatal and nonfatal stroke. As effective hypertension therapy is available, regular blood pressure screening may be conducted even in apparently healthy individuals.