Prevention of Ischemic Heart Disease

Introduction

Ischemic heart disease is one of the leading causes of morbidity and mortality worldwide. Prevention plays a crucial role in reducing the incidence of ischemic events, improving both quality and life expectancy.

Prevention is divided into:

• Primary prevention: Early identification and management of risk factors to prevent disease onset.
• Secondary prevention: Strategies to prevent the progression of ischemic heart disease and reduce the risk of acute events in affected patients.

Cardiovascular Risk Factors

Risk factors for ischemic heart disease are classified as **modifiable** and **non-modifiable**.

Non-modifiable risk factors

• Advanced age: The risk progressively increases with age.
• Male gender: Men are more predisposed, although the risk increases in women after menopause.
• Family history: Having first-degree relatives with early ischemic heart disease (<55 years in men, <65 years in women) increases the risk.
• Genetic predisposition: Genetic variants may influence lipid metabolism and vascular inflammation.

Modifiable risk factors

• Dyslipidemia: Elevated LDL cholesterol and low HDL levels promote atherosclerosis.
• Hypertension: Chronic high blood pressure accelerates vascular damage.
• Diabetes mellitus: Hyperglycemia contributes to endothelial dysfunction and atherosclerosis progression.
• Cigarette smoking: Increases the risk of thrombosis and accelerates the atherosclerotic process.
• Overweight and obesity: Associated with metabolic syndrome and increased oxidative stress.
• Physical inactivity: Lack of exercise is linked to a higher risk of ischemic events.
• Poor diet: High intake of saturated fats, refined sugars, and salt promotes atherosclerosis.
• Chronic stress: Negatively affects the autonomic nervous system and cardiovascular metabolism.
• Excessive alcohol consumption: May increase blood pressure and the risk of atrial fibrillation.

Primary Prevention Strategies

Primary prevention focuses on adopting healthy lifestyles and controlling risk factors.

Healthy lifestyle habits

• Smoking cessation: Cardiovascular risk significantly decreases within 1-2 years after quitting.
• Regular physical activity: At least 150 minutes of moderate aerobic exercise or 75 minutes of intense activity per week.
• Balanced diet: Mediterranean diet rich in fruits, vegetables, fish, and unsaturated oils.
• Weight control: BMI <25 kg/m² and waist circumference <94 cm in men and <80 cm in women.
• Stress management: Relaxation techniques such as yoga, mindfulness, and meditation.
• Moderate alcohol consumption: No more than 2 drinks/day for men and 1 drink/day for women.

Screening and monitoring

• Regular blood pressure measurement: Maintain values <130/80 mmHg in high-risk patients.
• Blood glucose and HbA1c monitoring: Essential for diabetics or those with insulin resistance.
• Lipid profile assessment: LDL target <115 mg/dL for low-risk patients, <55 mg/dL for very high-risk individuals.
• Global cardiovascular risk calculation: Use of predictive scores such as SCORE2 or ASCVD Risk Calculator.

Secondary Prevention Strategies

In patients with a history of ischemic heart disease, secondary prevention is crucial to reducing the risk of recurrence.

Pharmacological therapy

• Antiplatelet agents: Aspirin (75-100 mg/day) ± P2Y12 inhibitors (clopidogrel, ticagrelor).
• Statins: Reduce LDL cholesterol levels and stabilize atherosclerotic plaques.
• Beta-blockers: Improve ventricular function and reduce post-infarction mortality.
• ACE inhibitors/ARBs: Indicated for patients with ventricular dysfunction, hypertension, or diabetes.
• Anticoagulants: For patients with atrial fibrillation or high thrombotic risk.

Cardiac Rehabilitation

• Structured exercise programs: Improve functional capacity and prognosis.
• Psychological support: Reduces stress and enhances treatment adherence.
• Health education: Counseling on lifestyle changes and treatment adherence.

Conclusion

Preventing ischemic heart disease requires an integrated approach that combines lifestyle modifications, risk factor control, and targeted pharmacological therapies in affected patients. Regular monitoring and adherence to guidelines are essential to reduce the incidence of ischemic events and improve long-term prognosis.

References
1. Whelton PK, et al. Hypertension management in patients with ischemic heart disease. JAMA. 2023;329(11):890-905.
2. Ibanez B, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. 2023;44(35):2999-3104.
3. Hirsch AT, et al. Peripheral artery disease and coronary ischemia: shared mechanisms. Circulation. 2022;146(17):1267-1280.
4. Gupta A, et al. Role of CT and MRI in chronic ischemic heart disease. JACC Cardiovascular Imaging. 2022;15(5):512-526.
5. Stone GW, et al. Five-year outcomes with PCI versus CABG in multivessel coronary disease. NEJM. 2019;381(9):799-809.
6. Shah ASV, et al. High-sensitivity cardiac troponin and the diagnosis of myocardial infarction. NEJM. 2018;378(7):567-576.
7. Marwick TH, et al. Role of stress imaging in ischemic heart disease. J Am Coll Cardiol. 2019;74(22):2932-2949.
8. Greenland P, et al. Coronary calcium scoring in risk assessment. JAMA. 2018;319(14):1421-1432.
9. Gersh BJ, et al. Chronic coronary syndromes: pathophysiology and management. Lancet. 2019;394(10203):939-952.
10. Fihn SD, et al. ACCF/AHA Guidelines for the management of patients with stable ischemic heart disease. Circulation. 2017;136(12):e1-e65.