1
Primary prevention of
atherosclerotic cardiovascular
diseases
Lifestyle-oriented recommendations and advice
Department of Public Health, Faculty of Medicine, Masaryk University
2
Basic documents (guidelines) for prevention of ASCVD
̶ 2016 European guidelines on CD prevention in clinical practice
 European Heart Journal (2016) 37, 2315–2381
www.athero.cz/media/1542/2016-esc-eas-eacpr.pdf
̶ 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
 Circulation. 2019;140:e596–e646
ASCVD = AtheroSclerotic CardioVascular Disease
ACC = American College of Cardiology
AHA = American Heart Association
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
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Cardiovascular Diseases Prevention – Definition and Rationale
Cardiovascular disease (CVD) prevention is defined as a coordinated set of actions, at the population level or
targeted at an individual, that are aimed at eliminating or minimizing the impact of CVDs and their related
disabilities
Definition of CVD prevention:
Current state and trends:
• CVD remains a leading cause of morbidity and mortality, despite improvements in outcomes.
• Age-adjusted coronary artery disease (CAD) mortality has declined since the 1980s, particularly in high-income
regions. CAD rates are now less than half what they were in the early 1980s in many countries in Europe, due
to preventive measures including the success of smoking legislation.
• However, inequalities between countries persist and many risk factors, particularly obesity and diabetes mellitus
(DM), have been increasing substantially. If prevention was practised as instructed it would markedly reduce
the prevalence of CVD. It is thus not only prevailing risk factors that are of concern, but poor implementation
of preventive measures as well.
Efficiency:
Prevention is effective: the elimination of health risk behaviours would make it possible to
prevent at least 80% of CVDs and even 40% of cancers.
Prevention should be delivered:
(i) at the general population level by promoting healthy lifestyle behaviour and
(ii) at the individual level, i.e. in those subjects at moderate to high risk of CVD or patients with established CVD,
by tackling unhealthy lifestyles (e.g. poor-quality diet, physical inactivity, smoking) and by optimising risk factors.
Lifestyle-oriented counselling in prevention
Department of Public Health, Faculty of Medicine, Masaryk University
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2016 European guidelines on CD prevention in clinical practice
European Heart Journal - Eur Heart J. 2016 Aug 1; 37(29): 2315–2381
„Class“ = Classes of recommendations
„Level“ = Level of evidence:
This document has been developed
to support healthcare professionals
communicating with individuals
about their cardiovascular (CV) risk
and the benefits of a healthy
lifestyle and early modification of
their CV risk.
In addition, the guidelines provide
tools for healthcare professionals to
promote population-based strategies
and integrate these into national or
regional prevention frameworks and
to translate these in locally delivered
healthcare services, in line with the
recommendations of the World
Health Organization (WHO) global
status report on non-communicable
diseases 2010.
Lifestyle-oriented counselling in prevention
Department of Public Health, Faculty of Medicine, Masaryk University
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SCORE – Systematic Coronary Risk Estimation
SCORE chart:
10-year risk of fatal
cardiovascular disease in
populations of countries
at high cardiovascular
risk based on the
following risk factors:
- Age,
- Sex,
- Smoking,
- Systolic blood pressure,
- Total cholesterol.
High risk countries:
Bosnia and Herzegovina,
Croatia, Czech Republic,
Estonia, Hungary, Lithuania,
Montenegro, Morocco,
Poland, Romania, Serbia,
Slovakia, Tunisia and
Turkey
Advantages
• Intuitive, easy to use tool.
• Establishes a common language of risk for
healthcare professionals.
• Allows a more objective assessment of
risk.
• Takes account of the multifactorial nature
of CVD.
• Allows flexibility in management; if an
ideal risk factor level cannot be achieved,
total risk can still be reduced by reducing
other risk factors.
• Deals with the problem of a low absolute
risk in young people with multiple risk
factors: the relative risk chart helps to
illustrate how a young person with a low
absolute risk may be at a substantially
high and reducible relative risk; calculation
of an individual’s “risk age” may also be of
use in this situation.
Limitations
• Estimates risk of fatal but not total (fatal +
non-fatal) CV risk for
• reasons outlined in text.
• Adapted to suit different European
populations, but not different
• ethnic groups within these populations.
• Limited to the major determinants of risk.
• Other systems have more functionality,
although applicability to
• multiple countries is uncertain.
• Limited age range (40–65 years).
Low risk:
Andorra, Austria,
Belgium, Cyprus,
Denmark, Finland,
France, Germany,
Greece, Iceland, Ireland,
Israel, Italy, Luxembourg,
Malta, Monaco, The
Netherlands, Norway,
Portugal, San Marino,
Slovenia, Spain, Sweden,
Switzerland and the
United Kingdom.
Lifestyle-oriented counselling in prevention
Low- to moderate-risk persons
(calculated SCORE <5%):
should be offered lifestyle advice to
maintain their low- to moderate-risk
status.
High-risk persons (calculated SCORE
≥5% and <10%):
qualify for intensive lifestyle advice and
may be candidates for drug treatment.
Very-high-risk persons (calculated
SCORE ≥10%):
drug treatment is more frequently
required.
Department of Public Health,
Faculty of Medicine, Masaryk University
6
Lifestyle factors affecting cardiovascular risk and other risk factors for
behavioral intervention
̶ Sedentary behavior and physical activity
 Prescription of PA, aerobic PA, Strengthening -resistance exercises, neuromotor PA
̶ Smoking interventions
 Doses and types, Passive smoking, mechanisms, smoking cessation, electronic cigarettes
̶ Nutrition
 Fatty acids
 Minerals
 Vitamins
 Fibre
 Foods and food groups (Vegetables and Fruits, Nuts, Fish, Soft drinks and sugar)
 Dietary patterns
 Functional foods
̶ Alcohol
 The question of the relationship between alcohol consumption (dose) and cardiovascular risk
̶ Body weight
 Which index of obesity is the best predictor od cardiovascular risk, goals, does metabolically healthy obesity exist?
̶ Lifestyle intervention for Lipid control
̶ Lifestyle intervention for Glucose control and type 2 DM
̶ Lifestyle intervention for Blood Pressure lowering
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
7
2016 European guidelines on CD prevention in clinical practice
European Heart Journal - Eur Heart J. 2016 Aug 1; 37(29): 2315–2381
Class of recommendations:
Recommendations for assessment of family history/(epi)genetics
Level of evidence:
Familial history of premature CVD is a crude but simple indicator of the risk of developing CVD, reflecting both the genetic trait and the environment
shared among household members. A positive family history of premature CV death is associated with an increased risk of early and lifetime CVD.
A family history of premature CVD is simple, inexpensive information that should be part of the CV risk assessment in all subjects. Family history can be
a risk modifier to optimal management after the calculated risk using SCORE lies near a decisional threshold: a positive family history would favour more
intensive interventions, while a negative family history would translate into less intensive treatment
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
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2016 European guidelines on CD prevention in clinical practice
Psychosocial factors
Recommendation for assessment of psychosocial risk factors:
Key messages:
 Low socio-economic status, lack of social support, stress at work and in family life, hostility, depression, anxiety and other mental disorders contribute
to the risk of developing CVD and a worse prognosis of CVD, with the absence of these items being associated with a lower risk of developing CVD and
a better prognosis of CVD.
 Psychosocial risk factors act as barriers to treatment adherence and efforts to improve lifestyle, as well as to promoting health in patients and
populations.
Mechanisms that link psychosocial factors to increased CV risk include unhealthy lifestyle [more frequent smoking, unhealthy food choices and less physical activity (PA)]
and low adherence to behaviour change recommendations or CV medication. In addition, depression and/or chronic stress are associated with alterations in autonomic
function, in the hypothalamic–pituitary axis and in other endocrine markers, which affect haemostatic and inflammatory processes, endothelial function and myocardial
perfusion. Enhanced risk in patients with depression may also be due in part to adverse effects of tricyclic antidepressants
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
Class of
recommendations:
Level of evidence:
9
2016 European guidelines on CD prevention in clinical practice
European Heart Journal - Eur Heart J. 2016 Aug 1; 37(29): 2315–2381
Psychosocial factors
Core questions for the
assessment of
psychosocial risk factors
in clinical practice:
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health,
Faculty of Medicine, Masaryk University
10
 Prescription of PA, aerobic PA, Strengthening -resistance
exercises, neuromotor PA
Key messages:
 Regular PA is a mainstay of CV prevention;
participation decreases all-cause and CV
mortality.
 PA increases fitness and improves mental health.
 Sedentary subjects should be encouraged to start
light-intensity aerobic PA.
Physical activity
Recommendations
for physical activity:
• MET (metabolic equivalent) is estimated as the energy
cost of a given activity divided by resting energy
expenditure: 1 MET = 3.5 mL O2 kg-1 min-1 oxygen
consumption (VO2).
• RPE, rating of perceived exertion (20 value Borg
score).
• %HRmax, percentage of measured or estimated
maximum heart rate (220-age).
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health,
Faculty of Medicine, Masaryk University
Class of recommendations:
Level of evidence:
Classification of physical activity intensity and examples of absolute and relative intensity levels:
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Smoking intervention
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health,
Faculty of Medicine, Masaryk University:
Class of recommendations:
Level of evidence:
Key messages:
 Stopping smoking is the most cost-effective strategy for CVD prevention.
 There is a strong evidence base for brief interventions with advice to stop smoking, all types of nicotine replacement therapy (NRT), bupropion,
varenicline and greater effectiveness of drugs in combination, except for NRT plus varenicline. The most effective are brief interventions plus
assistance with stopping using drug therapy and follow-up support.
 Electronic cigarettes (e-cigarettes) may help in smoking cessation but should be covered by the same marketing restrictions as cigarettes.
 Passive secondary smoking carries significant risk, with the need to protect non-smokers
Recommendations for smoking intervention strategies: The “Five As” for a smoking cessation strategy for routine practice:
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Nutrition
Recommendation on nutrition:
Healthy diet characteristics:
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Key messages::
 Dietary habits influence the risk of CVD and other chronic diseases such as cancer.
 Energy intake should be limited to the amount of energy needed to maintain (or obtain) a healthy weight, that is, a BMI >20.0 but < 25.0
kg/m2.
 In general, when following the rules for a healthy diet, no dietary supplements are needed.
The impact of diet is studied on three levels: specific
nutrients, specific foods/food groups and specific
dietary patterns, of which the Mediterranean diet is
the most studied.
The nutrients of interest with respect to CVD are fatty
acids (which mainly affect lipoprotein levels), minerals
(which mainly affect BP), vitamins and fibre.
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13
Main dietary fatty acids
https://ec.europa.eu/jrc/en/health-
knowledge-gateway/promotion-
prevention/nutrition/fats
It is produced
industrially – by
hardening of fats
Vacca = lat. Cow
Mammals convert it
from Vaccenic acid. It is
conjugated LA (= CLA)
SCFA (Short Chain Fatty Acids) - <6 C
MCFA (Medium Chain) – 6-12 C
LCFA (Long Chain) – 14-22c
SCFA and MCFA are important
food components where they are
mostly in the form of triglycerides
in some vegetable oils and milk
Nevertheless, bacterial fermentation
of amylase-resistant starch and
nonstarch polysaccharides in the gut is
probably the most important source
of SCFAs in humans and most
mammalian species.
Department of Public Health,
Faculty of Medicine, Masaryk University:
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Nutrition
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
15
https://ec.europa.eu/jrc/en/health-knowledge-gateway/promotion-prevention/nutrition/fats
Palm oil:
(from the flesh of oil
palm fruit)
50% SFA
40% MUFA
10% PUFA
Palm kernel oil:
(from the kernels of
palm oil fruits)
82 % SFA
16 % MUFA
2 % PUFA
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Main dietary sources of various fatty acids
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Fatty acid content in various fats
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
In % of total fat content
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Composition of fats in nuts and seeds
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
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Fats overview:
Poradenství v prevenci orientované na životní styl – prevence ASKVN
Department of Public Health,
Faculty of Medicine, Masaryk University
Department of Public Health, Faculty of Medicine, Masaryk University
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Lifestyle-oriented counselling in prevention - Introduction
Fig 2:Effect of high-fat versus low-fat diets on cardiometabolic risk factors
Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nature Reviews Cardiology,16(2019)581–6
Differences in total fat consumption are not related to the incidence of either
cardiovascular events or type 2 diabetes
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Fig 3:Effect of replacing dietary saturated fatty acids on cardiometabolic lipid risk factors
Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nature Reviews Cardiology,16(2019)581–601
Effect of replacement of SFA with different possibilities‚ (carbohydrates, MUFAs, PUFAs) on
cardiometabolic risk lipid factors
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
Department of Public Health, Faculty of Medicine, Masaryk University
21
Lifestyle-oriented counselling in prevention - Introduction
Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nature Reviews Cardiology,16(2019)581–601
Effect of replacing SFA with different alternatives (carbohydrates, MUFAs, PUFAs) on the risk of
coronary heart disease
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Dietary fats and cardiometabolic disease: mechanisms and effects on risk factors and outcomes. Nature Reviews Cardiology,16(2019)581–601
Ústav ochrany a podpory zdraví LF MU
Lifestyle-oriented counselling in prevention - Introduction
Dietary sources of saturated fats and the risk of cardiometabolic disease
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Nutrition - minerals
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
Department of Public Health, Faculty of Medicine, Masaryk University
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Nutrition - Vitamins
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Nutrition - Fibre
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
26
Nutrition – fruit and vegetables, nuts
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Nutrition - Fish
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Alcohol
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Soft drinks and sugar
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Dietary patterns (Mediterranean diet), functional foods
Department of Public Health, Faculty of Medicine, Masaryk University
Lifestyle-oriented counselling in prevention – Cardiovascular Diseases
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Lifestyle factors affecting cardiovascular risk and other risk factors for behavioral intervention
Counseling in lifestyle oriented prevention - ASCVD prevention
Body weight
1BMI 20–25 kg/m2. There is evidence that optimal weight in elderly is higher than in the young and middle-aged.
Department of Public Health, Faculty of Medicine, Masaryk University
Key messages
 Both overweight and obesity are associated with an increased risk of CVD death and all-cause mortality. All-cause mortality is lowest
with a BMI of 20–25 kg/m2 (in those <60 years of age); further weight reduction cannot be considered protective against CVD
 Healthy weight in the elderly is higher than in the young and middle-aged.
 Achieving and maintaining a healthy weight has a favourable effect on metabolic risk factors (BP, blood lipids, glucose tolerance) and
lower CV risk.
Recommendation for body weight:
Does ‘metabolically healthy obesity’ exist?
 The phenotype of ‘metabolically healthy obesity’ (MHO), defined by the presence of obesity in the absence of metabolic risk factors, has gained a lot
of interest.
 Some studies argue that a specific subgroup of obese individuals is resistant to metabolic complications such as arterial hypertension and insulin
resistance.
 However, MHO individuals present a higher all-cause mortality compared with normal weight metabolically healthy individuals.343,344
 Long-term results from the Whitehall study support the notion that MHO is a transient phase345 moving towards glucometabolic abnormalities rather
than a specific ‘state’
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Lifestyle factors affecting cardiovascular risk and other risk factors for behavioral intervention
Counseling in lifestyle oriented prevention - ASCVD prevention
Lipid control
Department of Public Health, Faculty of Medicine, Masaryk University
Recommendations for lipid control:Key messages
 Elevated levels of plasma LDL-C are causal to
atherosclerosis.
 Reduction of LDL-C decreases CV events.
 Low HDL-C is associated with increased CV risk, but
manoeuvres to increase HDL-C have not been associated
with a decreased CV risk.
 Lifestyle and dietary changes are recommended for all.
 Total CV risk should guide the intensity of the
intervention.
 Total cholesterol and HDL-C are adequately measured on
nonfasting samples, thus allowing non-HDL-C to be
derived.
Each 1.0 mmol / l reduction in LDL-C reduces by 20-25%
CVD mortality and the incidence of non-fatal MI.
Norm in FN Brno:
Chol: 2.9 - 5.0
TG: 0.45 - 1,7
HDL-C 1,0 - 2,1
LDL-C 1,2 - 3,0
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Non-pharmacological reduction of blood cholesterol - I. Nutrition̶ Nutrition
 Reduce saturated fats
 Saturated fats, found primarily in red meat and full-fat dairy products (+coconut fat), raise total cholesterol. Decreasing
consumption of SFA reduce your LDL cholesterol.
 Eliminate trans fats
 Trans fats (industrially produced) raise overall cholesterol levels.
 TFAs, sometimes listed on food labels as "partially hydrogenated vegetable oil," are often used in margarines and store-bought
cookies, crackers and cakes. Trans fats raise overall cholesterol levels.
 The FDA (Food and Drug Administration) has banned the use of partially hydrogenated vegetable oils by Jan. 1, 2021.
 Increase soluble fiber
 Soluble fiber reduce the absorption from intestine, thereby lowering its blood level.
 It is found in such foods as oatmeal, kidney beans, Brussels sprouts, apples and pears.
 Add whey protein
 Whey protein, lowers both LDL cholesterol and total cholesterol as well as BP
 It is found in dairy products. It can be obtained by removing casein from the milk when a solid component (casein, curd) and a
liquid whey are formed after clotting
 It can cause a number of health benefits that dairy products have.
 Compared to other protein sources, it contains relatively more BCAA - Branched Chain Amino Acids (valine, isoleucine and leucine)
 Fytosterols
 Plant sterols, naturally occurring in plant membranes. Due to a similar structure, they compete with cholesterol for absorption
(reabsorption) in the intestine.
 Intake of 2g/day reduces total cholesterol by 10 % and LDL-C by 14 %.
 They occur naturally, especially in vegetable oils, nuts, pulses, whole grains, fruits and vegetables, but the average intake is <0.5
g, i.e. supplementation (or food fortification) is required.
 Soya, soya products
 Intake of soy products leads to a significant reduction in LDL-C, TAG and total cholesterol (TC). It also leads to a significant
increase in HDL-C (Metaanalysis RCT, 2015).
 The effect is caused by soy proteins. The effect is stronger in hypercholesterolomic subjects. Soy products are more effective than
soy supplements.
 Foods rich in omega-3 FA
 Omega-3 fatty acids don't affect LDL cholesterol. But they have other heart-healthy benefits, including reducing blood
pressure. Foods with omega-3 fatty acids include salmon, mackerel, herring, walnuts and flaxseeds.
Counseling in lifestyle oriented prevention - ASCVD prevention
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Non-pharmacological lowering of blood cholesterol - continued
 Physical activity
 Physical activity increases HDL-C and lowers total cholesterol.
 Exercise (engage in sports, physical activity) most days of the week and increase your physical activity.
 Smoking
 Smoking reduces HDL-C, quitting smoking improves HDL-C and thus lipid profile and can lower total cholesterol.
 In addition, it is itself the most important cardiovascular risk factor and modifies the effect of cholesterol as RF
 Body weight
 Excessive weight contributes to high cholesterol.
 Reducing excessive weight reduces LDL-C and improves its reduction
 Alcohol
 Moderate alcohol consumption is associated with higher HDL-C levels, but the benefit is not strong enough to justify
recommending alcohol to anyone who is no longer drinking.
 If you drink alcohol, do it in moderationy. For healthy adults, this is a maximum of 1 drink/ day for women of all ages and for
men ≥65 and up to 2 drinks/day for men under 65.
 Too much alcohol leads to serious health problems, including hypertension, heart failure stroke.
Counseling in lifestyle oriented prevention - ASCVD prevention
Department of Public Health, Faculty of Medicine, Masaryk University
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Counseling in lifestyle oriented prevention - ASCVD prevention
Blood pressure
Recommendation for management of hypertension:
 Lifestyle interventions, weight control and regular PA alone may be
sufficient for patients with high-normal and grade 1 hypertension, and
should always be advised for patients receiving BP-lowering
drugs, as these may reduce the dosage of BP-lowering drugs needed
to achieve BP control.
 The lifestyle intervention specific to hypertension is salt restriction. At
the individual level, effective salt reduction is by no means easy to
achieve. As a minimum, advice should be given to avoid added salt and
high-salt food.
Lifestyle intervention:
Definition and classification of blood pressure levels
Blood pressure thresholds for definition of hypertension with different types
of BP measurement:
Key messages
 Elevated BP is a major risk factor for CAD, HF, cerebrovascular disease,
PAD, CKD and AF.
 The decision to start BP-lowering treatment depends on the BP level and
total CV risk.
 Benefits of treatment are mainly driven by BP reduction per se, not by
drug type.
 Combination treatment is needed to control BP in most patients
 Office BP is recommended for screening and diagnosis of hypertension,
which should be based on at least two BP measurements per visit
and on at least two visits.
 If the BP is only slightly elevated, repeated measurements should be
made over a period of several months to achieve an acceptable
definition of the individual’s ‘usual’ BP and to decide about initiating
drug treatment.
Department of Public Health,
Faculty of Medicine,
Masaryk University
36
Non-pharmacological means to reduce high blood pressure
 Natrium
 Even a slight decrease in sodium intake of 1 g/day reduces syst. BP in patients with hypertension by 3.1 mmHg and in patients
with normotension by 1.6 mmHg.
 A study of Dietary Approaches to Stop Hypertension (DASH) showed a dose-response relationship between sodium reduction
and BP reduction.
 The recommended maximum intake of NaCl is 5 g/day. The optimal level is around 3 g/day.
 80 % of salt intake comes from processed foods, while only 20 % is added later.
 Standard DASH (Mayo): Allows intake of max. 2.3 g Na (= 5.75 g NaCl per day).
 Low sodium DASH: Permits max. 1.5 g Na per day (= 3.75 g NaCl)
 Dairy products (low fat)
Bioactive peptides:
 Casein and whey protein contain specific bioactive peptides that have been shown to have an ACE (Angiotensin I converting
enzyme) inhibitory effect, a key process in BP control.
 Certain combinations of peptides in milk have hypotensive effects also through modulation of endothelin-1 release by
endothelial cells.
 For cheese, casein-derived bioactive peptides are relevant; for example, the specific tripeptides isoleucine-proline-proline
(Ile-Pro-Pro) and valine-proline-proline (Val-Pro-Pro) have been shown to have antihypertensive activity. Significant reductions
of 4.8 mmHg in systolic BP and 2.2 mmHg in diast BP were found.
Calcium:
 Ca is considered to be one of the major nutrients responsible for the beneficial impact of dairy products on BP control.
 Calcium contributes to the regulation of blood pressure by controlling the contractility of vascular smooth muscle cells and thereby
modulating peripheral vascular resistance.
 In addition, extracellular ionized calcium inhibits renin secretion by interaction with the calcium receptor
 Other minerals in milk, such as magnesium and potassium, may also help regulate BP, but their individual contributions are difficult
to isolate because they are often found in calcium-rich foods.
 Potassium - fruits and vegetables
 Potassium has beneficial effects on BP (well documented, eg by DASH). The main sources of potassium are fruits and
vegetables.
 Physical activity
 Regular physical activity is important for maintaining normal BP, it can significantly reduce BP.
 Body weight control
 Excessive weight significantly increases BP. Weight reduction significantly reduces BP
 Alcohol
 Any alcohol consumption increases BP
Counseling in lifestyle oriented prevention - ASCVD prevention
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DASH - Dietary Approaches to Stop Hypertension
Poradenství v prevenci orientované na životní styl
https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
DASH dieta vznikla v 90. letech. V roce 1992 začal NIH (National Institute of Health, USA
organizoval výzkum ke zjištění, zda nějaká konkrétní výživová intervence je užitečné při
léčbě hypertenze. Zjistili, že pouze výživová intervence dokázala snížit syst TK o 6-11
mmHg.
DASH je i cesta k prevenci hypertenze.
Nabádá ke stravě bohaté na draslík, vápník a hořčík a ke snížení příjmu sodíku.
Je bohatá na zeleninu, celozrnné potraviny, ovoce, ryby, maso, drůbež, ořechy, fazole a
nízkotučné mléčné výrobky.
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Nefarmakologické prostředky ke snížení vysokého TK
Poradenství v prevenci orientované na životní styl
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DASH dieta
Skupina potravin Počet porcí denně/týdně Příklad porce
Obiloviny 6-7 porcí denně
1 plátek celozrnného chleba, ½ šálku vařených celozrnných
obilovin, rýže nebo těstovin
Zelenina 4-5 porcí denně
1 šálek syrové listové zeleniny, ½ šálku syrové nebo vařené
zeleniny
Ovoce 4-5 porcí denně
1 střední kousek ovoce, ½ šálku syrového, mraženého nebo
zavařeného ovoce, malá sklenice džusu (125 ml)
Mléčné výrobky 2-3 porcí denně
1 šálek mléka nebo jogurtu s nízkým obsahem tuku (240 ml), 40 g
sýra s nízkým obsahem tuku
Libové maso, drůběž nebo ryby 6 porcí týdně nebo méně Maximálně 85 g na porci
Tuky a oleje 2-3 porcí denně
1 lžička rostlinného nebo olivového oleje, 1 lžička margarínu, 2 lžíce
salátového dressinku
Ořechy, semena a luštěniny 4-5 porcí týdně 50 g ořechů, 2 lžíce semen nebo ½ šálku vařených luštěnin
Sladkosti 5 porcí týdně nebo méně
1 lžíce cukru nebo džemu, ½ šálku sorbetu nebo 1 slazený nápoj
(250 ml)
Dietary Approaches to Stop Hypertension
- dostatek zeleniny, ovoce, celozrnných obilovin, nízkotučných mléčných výrobků, ryb, drůbeže, luštěnin, ořechů
a rostlinných olejů
- omezení potravin bohatých na nasycené MK (masné výrobky, plnotučné mléčné výrobky, tropické oleje jako
kokosový a palmový)
- omezení slazených nápojů a sladkostí
- max. denní přívod sodíku 2300 mg
Snížení hmotnosti, obvodu pasu, hladiny cholesterolu
snížení kardiometabolického rizika
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Doporučení dle nemocí – Kardiovaskulární nemoci
2016 European guidelines on CD prevention in clinical practice
European Heart Journal - Eur Heart J. 2016 Aug 1; 37(29): 2315–2381
Cíle ohledně rizikových faktorů a cílové hodnoty důležitých kardiovaskulárních rizikových faktorů:
BMI = index tělesné hmotnosti; HbA1c = glykovaný hemoglobin; HDL-C = lipoproteinový cholesterol s vysokou hustotou; LDL-C = lipoproteinový cholesterol s nízkou hustotou.
aKrevní tlak <140/90 mmHg je obecný cíl. Cíl může být vyšší u křehkých (frail) starších pacientů nebo u většiny pacientů s DM a u některých (velmi) vysoce rizikových pacientů bez DM, kteří
mohou tolerovat vícečetné léky snižující krevní tlak.
bNon-HDL-C je rozumný a praktický alternativní cíl, protože nevyžaduje odběr nalačno. Pro jedince s velmi vysokým, vysokým a nízkým až středním rizikem se jako sekundární cíl doporučují
hodnoty non-HDL-C <2,6, <3,3 a <3,8 mmol/L (<100, <130 a <145 mg / dl).
cByl vysloven názor, že lékaři primární péče by mohli dávat přednost jedinému obecnému cíli LDL-C 2,6 mmol/l (100 mg / dl). I když přijímáme jednoduchost tohoto přístupu a že by to mohlo
být užitečné v některých prostředích, existuje lepší vědecká podpora pro tři cíle odpovídající úrovni rizika.
bToto je obecné doporučení pro osoby s velmi vysokým rizikem. Je třeba poznamenat, že důkazy u pacientů s CKD (chronickým onemocněním ledvin) jsou méně silné.
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Intervention of risk factors at individual level - behavioral change
Ústav ochrany a podpory zdraví LF MU
Key message
• Cognitive behavioural methods are effective in supporting persons in adopting a healthy lifestyle.
 It is important to explore each patient’s experiences, thoughts, worries, previous knowledge and circumstances of everyday
life. Individualized counselling is the basis for motivation and commitment.
 Decision-making should be shared between the caregiver and patient (including also the individual’s spouse and family).
 Use of the principles of effective communication236 (Table 8) will facilitate treatment and prevention of CVD
Lifestyle’ is usually based on long-standing behavioural patterns that are maintained by social environment. Individual and
environmental factors impede the ability to adopt a healthy lifestyle, as does complex or confusing advice from caregivers
Recommendations for facilitating changes in behaviour:
Class of remmendations
doporučení:
Level of efvidence
Counseling in lifestyle oriented prevention - ASCVD prevention
42
Intervence rizikových faktorů na individuální úrovni – behaviorální změna
Poradenství v prevenci orientované na životní styl – prevence ASKVN
Ústav ochrany a podpory zdraví LF MU
Principles of effective communication to
facilitate behavioural change
Ten strategic steps to facilitate behaviour change
43
Intervence rizikových faktorů na individuální úrovni – behaviorální
změna
̶ WHOxxxxx
 http
Poradenství v prevenci orientované na životní styl – prevence ASKVN
Ústav ochrany a podpory zdraví LF MU
Klíčová zpráva:
• Kognitivní behaviorální metody jsou účinné při podpoře osob při osvojování si zdravého životního stylu
It is important to explore each patient’s experiences, thoughts, worries, previous knowledge and circumstances of everyday life. Individualized counselling is
the basis for motivation and commitment. Decision-making should be shared between the caregiver and patient (including also the individual’s spouse and
family). Use of the principles of effective communication236 (Table 8) will facilitate treatment and prevention of CVD.
Lifestyle’ is usually based on long-standing behavioural patterns that are maintained by social environment. Individual and environmental factors impede
the ability to adopt a healthy lifestyle, as does complex or confusing advice from caregivers.
44
Faktory životního stylu ovlivňující kardiovaskulární riziko a další rizikové faktory k behaviorální intervenci
̶ Výživa –mastné kyseliny
Poradenství v prevenci orientované na životní styl – prevence ASKVN
Ústav ochrany a podpory zdraví LF MU