DALLAS -- The American Heart Association revised its prevention guidelines for heart attack survivors to recommend wider use of beta-blockers and drugs called ACE-inhibitors, along with more aggressive control of risk factors.
The guidelines, recommended jointly with the American College of Cardiology, incorporate recommendations from clinical trials completed since original guidelines were published in 1995. They are to be published in Tuesday's issue of Circulation, a journal of the American Heart Association.
"We felt the evidence is so powerful over last two or three years that these needed to be updated," said Dr. Sidney C. Smith, chief science officer of the AHA. "These medical therapies can significantly extend lives and quality of lives as well as diminish future procedures."
A major change in the guidelines, first announced by the AHA in July, recommends that women not be prescribed estrogen solely to prevent strokes and heart disease, because of growing evidence that the supplements might cause harm.
Doctors long believed that hormone supplements are good for women's hearts. But the heart association - one of the most authoritative organizations in the field of heart disease prevention - cites conflicting evidence that has come out over the past few years. Studies have suggested that in some cases, women had a higher risk of heart problems if they took hormone replacement therapy.
The heart association said that women taking hormones for the non-cardiac benefits do not need to stop. But women should not start taking hormones simply to prevent heart trouble. Hormone supplements are prescribed to about 20 million American women, mostly to treat hot flashes and other post-menopausal symptoms and to lower the risk of brittle bones.
Also, heart attack survivors should be treated more widely with drugs called ACE inhibitors and beta blockers. Beta blockers work by blocking the body's response to the high levels of stress-related hormones that pour into the bloodstream of heart failure patients. ACE inhibitors widen blood vessels, reducing stress on the heart.
Patients also should be given cholesterol-lowering drugs before hospital discharge, the guidelines emphasize. Smith said only one-third of eligible heart attack patients are prescribed the drugs while hospitalized.
"The patient's acceptance of these therapies is greater in the hospital," Smith said. "The hospital environment is an important location to introduce these therapies."
Patients also should avoid secondhand smoke, eat foods high in omega-3 fatty acids and use new antiplatelet agents if they are unable to take aspirin to reduce blood clotting.
The guidelines are important because as the American population ages, so does the incidence of cardiovascular disease, Smith said. Also type 2 diabetes is on the rise and two-thirds of deaths in diabetic patients are from cardiovascular disease.
"Much of what is stated here has already been incorporated by several people in practice, but there are still a lot of people who are not very much at the cutting edge of research," said Dr. Salim Yusuf of the Population Health Institute of McMaster University in Hamilton, Ontario.
"It's a very influential study, in essence telling us what the rules of the game should be," he said.
American College of Cardiology: http://www.acc.org/
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