Recently, the American College of Cardiology and the American Heart Association released several new guidelines regarding cholesterol management, obesity management, risk assessment and lifestyle intervention to reduce cardiovascular risk. The guidelines, written by Dr. R. Eckel, and Dr. J. Jakicic, and published in the journals Circulation and the Journal of the American College of Cardiology tackle, for the first time, an overlooked health issue: the importance of lifestyle management to diseases.
According to Dr. Eckel, the purpose of the new guidelines is to provide an update on what a healthy lifestyle is, with the intention of preventing cardiovascular disease in at-risk people. “The recommendations cover evidence related to dietary patterns, nutrient intake, and levels and types of physical activity that play a major role in cardiovascular disease prevention and treatment through effects on modifiable CVD risk factors, namely high LDL cholesterol and hypertension,” he said.
The recommendations are to:
1. Consume a diet high in fruits, vegetables, fish, whole grains, lean poultry, nuts, legumes, low-fat dairy, and non-tropical oils (a diet consistent with the Mediterranean-style diet).
2. Restrict the consumption of trans fat, saturated fat, sugar, sugar-sweetened beverages and salt.
3. Participate in 40 minutes of moderate to intense cardiovascular exercise, three to four times a week.
These nutritional recommendations, which promote a Mediterranean-style diet, differ from the previous recommendations which endorsed low-fat diets.
This is an excellent step for us all since the Mediterranean diet is backed by research and can prevent the onset of chronic disease. I also feel that the dietary restrictions are quite clear and helpful. I am especially pleased that reductions in sugar and sugar sweetened drinks are highly recommended in this report.
In my opinion, the recommendations regarding exercise do not go far enough and do not address common issues relative to an aging population: osteoporosis and sarcopenia. In order to build stronger bones and reach peak bone mass, resistance exercise needs to be encouraged at a young age.
This form of exercise is also extremely important in the prevention of osteoporosis later in life and it has been previously shown to prevent falls. Resistance exercise in the form of weight-training can also maintain muscle mass which has a tendency to disappear during the aging process placing those who experience it at greater risk of fractures and falls.
Sarcopenia is a condition of low muscle mass which can be completely prevented by the participation of a regular exercise program which stresses weight or resistance-training.
In my view, these new guidelines are a better version of the previous guidelines and may be helpful in the prevention of cardiovascular disease in at-risk people. However, they need to go even further if they are to reduce the burden of chronic disease and disability that our population faces as they age.
Wood, S.,“New ACC/AHA/NHLBI Guidance on Lifestyle for CVD Prevention,”Medscape web site, Nov 12 2013;http://www.medscape.com/viewarticle/814139, last accessed Nov 19, 2013.