編譯：黃龍飛審校：邊波 統籌：王雪天津醫科大學總醫院心內科NEW ORLEANS (March 17, 2019) — The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy eating plan, getting more exercise, avoiding tobacco and managing known risk factors are among the key recommendations in the 2019 Primary Prevention of Cardiovascular Disease guideline from the American College of Cardiology (ACC) and the American Heart Association (AHA). Also, it is recommended that aspirin should only rarely be used to help prevent heart attacks and stroke in people without known cardiovascular disease.新奧爾良（2019年3月17日）-我們所做的每一個選擇都會對自身心血管健康產生持久的影響。美國心臟病學會（ACC）和美國心臟協會（AHA）在《2019心血管疾病一級預防指南》中提出包括健康飲食、運動、戒煙和控制已知的危險因素（如高血壓、高血脂、高血糖）等關鍵性建議。此外，不建議應用阿司匹林對沒有心血管疾病的病人進行一級預防。The guideline, presented today at ACC’s 68th Annual Scientific Session, offers comprehensive but practical recommendations for preventing cardiovascular disease, which remains the leading cause of death for both men and women in the United States. Nearly 1 out of 3 deaths in the U.S. is due to cardiovascular disease.今天，在ACC第68屆年度科學會議上發布了該指南，其為預防心血管疾病提供了全面而實用的建議。在美國，心血管疾病仍然是主要死因，疾病死亡中的三分之一是由心血管疾病所引起的。“The most important way to prevent cardiovascular disease, whether it’s a build-up of plaque in the arteries, heart attack, stroke, heart failure or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart healthy habits and to do so over one’s lifetime,” said Roger S. Blumenthal, MD, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease and the Kenneth Jay Pollin Professor of Cardiology at Johns Hopkins Medicine. “More than 80 percent of all cardiovascular events are preventable through lifestyle changes, yet we often fall short in terms of implementing these strategies and controlling other risk factors.”“無論是動脈斑塊的發展、心臟病發作、卒中、心力衰竭、還是心臟如何收縮、血液如何泵入身體其他部位等問題，預防心血管疾病的關鍵方法都是采用有利于心臟健康的生活習慣，并貫穿一生，”2019年ACC / AHA心血管疾病一級預防指南聯合主席Roger S. Blumenthal博士和約翰霍普金斯醫學心臟病學Kenneth Jay Pollin教授說?！俺^80％的心血管事件都可以通過改變生活方式來預防，但在實施這些策略和控制其他風險因素方面，我們經常做的并不好?！?/section>The new prevention guideline, he said, is intended to provide a roadmap of strategies that can be used and tailored to help people without a history of heart disease stay heart healthy and, importantly, emphasize the need to identify and address personal or social barriers for doing so (e.g., income and education levels, cost concerns, lack of health insurance, access to healthy foods or safe places to exercise, life stressors).他指出，新的指南為心血管疾病一級預防提供了一條路線圖，以幫助那些沒有心臟病史的人保持心臟健康，并強調需要確定和解決實施中的個人或社會障礙（例如：收入和教育水平、成本問題、缺乏健康保險、健康食品或安全的運動場所、生活壓力等）。
Risk Assessment
According to the guideline, any effort to prevent a first instance of cardiovascular disease (called primary prevention) should ideally start with a thorough assessment of one’s risk—that is, estimating how likely someone is to develop blockages in their arteries and have a heart attack or stroke or die as a result. All patients should openly talk with their care team about their current health habits and personal risk for cardiovascular disease and, together, determine the best way to prevent it based on current evidence and personal preferences.根據該指南，任何預防首次心血管疾?。ǚQ為一級預防）的努力最好應從對個人風險的全面評估開始——即估計其動脈發生阻塞從而導致心臟病發作、卒中或死亡的可能性有多大。所有患者應開誠布公地與健康管理團隊討論其當前的健康習慣和心血管疾病的個人風險，并根據當前的證據和個人偏好共同確定預防心血管疾病的最佳方法。“We have good evidence now for how to identify these very high risk individuals with a physical exam and a good history, and for those at borderline risk there are additional factors that can help us determine who is at greater risk and should, for example, be on a medication like a statin earlier to prevent a cardiovascular event,” Blumenthal said. “In the past, a lot of people may have had a fatalistic attitude that they were going to develop heart problems sooner or later but, in reality, most cardiovascular events can be prevented.”Blumenthal說：“我們現在有充分的證據證明如何通過體檢和詳細的病史來識別這些高危人群，對于那些處于臨界風險的人群，有些方法可以幫助我們確定哪些人處于更高的風險中并且應該通過如早點服用他汀類藥物，來預防心血管事件?！?“在過去，很多人可能持有一種宿命論的態度，認為他們遲早會出現心臟問題，但事實上，大多數心血管事件都是可以預防的。”The document synthesizes the best data and proven interventions for improving diet and exercise, tobacco cessation and optimally controlling other factors that affect one’s likelihood of heart problems and stroke (e.g., obesity, diabetes, high cholesterol and high blood pressure). The document also discusses the challenges that may interfere with individuals being able to integrate better lifestyle habits.該指南綜合了最佳數據和被證實有效的干預措施，如改善飲食和增加運動、戒煙和控制其他可引起心臟問題和卒中的危險因素（如肥胖，糖尿病，高膽固醇和高血壓）。該指南還討論了可能影響人們建立良好生活習慣的因素。
Lifestyle Change Recommendations
The guideline underscores healthy lifestyle changes as the cornerstone of preventing heart disease and goes a step further by providing practical advice based on the latest research.該指南強調健康的生活方式改變是預防心臟病的基石，并在最新研究的基礎上提供實用的建議，從而更進一步。“We can all do better with our dietary and exercise habits, and that’s so important when we think about wanting to live longer and healthier lives, whether it’s to see our grandchildren grow up or to stay as active as possible in older age,” Blumenthal said.Blumenthal 說“無論是因為想看到我們的子孫長大成人，還是因為想要在年老時仍然保持活躍，當我們考慮想要更長壽、更健康的生活時，改善飲食和運動習慣都是非常重要的?！?/section>Some of the key lifestyle recommendations include: 一些主要的生活方式建議包括：· Eating heart healthier – choosing more vegetables, fruits, legumes, nuts, whole grains, and fish, and limiting salt, saturated fats, fried foods, processed meats, and sweetened beverages; specific eating plans like the Mediterranean, DASH and vegetarian diets are reviewed.·吃地更健康——我們回顧了地中海飲食，短跑飲食和素食飲食等特定飲食計劃。提出，進食更多的蔬菜，水果，豆類，堅果，粗糧和魚類，限制鹽，飽和脂肪，油炸食品，加工肉類和甜味飲料的攝入。· Engaging in regular exercise – experts advise aiming for at least 150 minutes of moderate-intensity exercises such as brisk walking, swimming, dancing or cycling each week. For people who are inactive, some activity is better than none and small 10-minute bursts of activity throughout the day can add up for those with hectic schedules. Currently, only half of American adults are getting enough exercise and prolonged periods of sitting can counteract the benefits of exercise.·定期鍛煉——專家建議每周至少進行150分鐘的中等強度運動，如快走，游泳，跳舞或騎自行車。對于那些不愛活動的人來說，有些活動總比沒有活動要好，每天忙碌的生活中可以適當進行10分鐘的高強度活動。目前，只有約一半的美國成人得到了足夠的鍛煉，長時間的坐著會抵消運動的好處。· Aiming for and keeping a healthy weight – for people who are overweight or obese, losing just 5 to 10 percent of their body weight (that would be 10-20 pounds for someone who weighs 200 pounds) can markedly cut their risk of heart disease, stroke and other health issues.·達到和保持健康的體重——對于超重或肥胖的人來說，只要減掉5%-10%的體重（對于體重200磅的人來說，減掉10-20磅）就能顯著降低他們患心臟病、卒中和其他健康問題的風險。· Avoiding tobacco by not smoking, vaping or breathing in smoke – 1 in 3 deaths from heart disease is attributable to smoking or exposure to secondhand smoke, so every effort to try to quit through counseling and/or approved cessation medications should be supported and tailored to each individual.·不吸煙也不吸入二手煙——心臟病死亡人數的1/3歸因于吸煙或接觸二手煙，因此應對每一個個體開展個體化的戒煙咨詢并使用以批準上市的戒煙藥物。
Aspirin Use
For people who’ve had a heart attack, stroke, open heart surgery or stents placed to open clogged arteries, aspirin can be lifesaving. But regular use of aspirin to prevent heart attacks and stroke in healthy people isn’t as clear-cut.對于心臟病發作、卒中、心臟直視手術或放置支架以開通阻塞動脈的患者來說，阿司匹林可以挽救他們的生命。但是在健康人中常規使用阿司匹林來預防心臟病發作和卒中并沒有那么明確的效益。In this guideline, ACC/ AHA experts offer science-based guidance that aspirin should only rarely be used to help prevent heart attacks and stroke in people without known cardiovascular disease. Recent research suggests that the chance of bleeding, given the blood-thinning effect of aspirin, may be too high and the evidence of benefit—the number of heart attacks or strokes that are actually prevented—is not sufficient enough to make a daily aspirin worth taking for most adults in this setting.在本指南中，ACC/AHA專家提供了基于科學的指導，即阿司匹林不應常規用于幫助那些沒有已知心血管疾病的人預防心臟病和卒中。最近的研究表明，考慮到服用阿司匹林有較高的出血風險，而且事實上預防心臟病發作的證據不足，因此基于這些證據我們不建議阿司匹林常規用于病人的一級預防。“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” Blumenthal said. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin. Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”Blumenthal說：“臨床醫生應該非常慎重地為沒有心血管疾病的人開阿司匹林處方。與推薦阿司匹林相比，優化生活習慣、控制血壓和膽固醇更為重要。阿司匹林應僅限于心血管疾病風險很高而出血風險低的人群。”Based on a simplified synopsis of the latest ACC/AHA cholesterol guideline, for primary prevention, statins should be commonly recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low density lipoprotein (LDL) cholesterol levels (≥ 190 mg/dl), Type 2 diabetes, and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors and having a detailed discussion with their clinician.基于最新ACC/AHA膽固醇指南，對于心血管疾病的一級預防，該指南提出，改善生活方式同時，應該對低密度脂蛋白膽固醇（LDL-C）水平升高（≥190mg/dl）、 2型糖尿病以及經臨床醫生-患者風險討論后確定有足夠的ASCVD風險的三類病人，推薦使用他汀類藥物以預防心血管疾病的發生。
Diabetes
For people with Type 2 diabetes, which is one of the strongest risk factors for cardiovascular disease, there are new data that two classes of diabetes medications, which work to lower blood sugar levels, can also cut the risk of heart attack, stroke and related deaths.2型糖尿病是心血管疾病最嚴重的危險因素之一。有數據表明，鈉-葡萄糖協同轉運蛋白2（SGLT-2）抑制劑和胰高血糖素樣肽-1受體（ GLP-1R）激動劑這兩類降糖藥物不僅能降血糖，同時能改善心血管獲益。The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease will simultaneously publish in the Journal of the American College of Cardiology and the American Heart Association’s journal Circulation.《2019年ACC/AHA心血管疾病一級預防指南》全文將同步發表在美國心臟協會《循環雜志》（Circulation）和《美國心臟病學會雜志》（JACC）。
