编译：黄龙飞审校：边波 统筹：王雪天津医科大学总医院心内科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.新奥尔良（2019年3月17日）-我们所做的每一个选择都会对自身心血管健康产生持久的影响。美国心脏病学会（ACC）和美国心脏协会（AHA）在《2019心血管疾病一级预防指南》中提出包括健康饮食、运动、戒烟和控制已知的危险因素（如高血压、高血脂、高血糖）等关键性建议。此外，不建议应用阿司匹林对没有心血管疾病的病人进行一级预防。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届年度科学会议上发布了该指南，其为预防心血管疾病提供了全面而实用的建议。在美国，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.”“无论是动脉斑块的发展、心脏病发作、卒中、心力衰竭、还是心脏如何收缩、血液如何泵入身体其他部位等问题，预防心血管疾病的关键方法都是采用有利于心脏健康的生活习惯，并贯穿一生，”2019年ACC / AHA心血管疾病一级预防指南联合主席Roger S. Blumenthal博士和约翰霍普金斯医学心脏病学Kenneth Jay Pollin教授说。“超过80％的心血管事件都可以通过改变生活方式来预防，但在实施这些策略和控制其他风险因素方面，我们经常做的并不好。”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，新的指南为心血管疾病一级预防提供了一条路线图，以帮助那些没有心脏病史的人保持心脏健康，并强调需要确定和解决实施中的个人或社会障碍（例如：收入和教育水平、成本问题、缺乏健康保险、健康食品或安全的运动场所、生活压力等）。
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.根据该指南，任何预防首次心血管疾病（称为一级预防）的努力最好应从对个人风险的全面评估开始——即估计其动脉发生阻塞从而导致心脏病发作、卒中或死亡的可能性有多大。所有患者应开诚布公地与健康管理团队讨论其当前的健康习惯和心血管疾病的个人风险，并根据当前的证据和个人偏好共同确定预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说：“我们现在有充分的证据证明如何通过体检和详细的病史来识别这些高危人群，对于那些处于临界风险的人群，有些方法可以帮助我们确定哪些人处于更高的风险中并且应该通过如早点服用他汀类药物，来预防心血管事件。” “在过去，很多人可能持有一种宿命论的态度，认为他们迟早会出现心脏问题，但事实上，大多数心血管事件都是可以预防的。”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.该指南综合了最佳数据和被证实有效的干预措施，如改善饮食和增加运动、戒烟和控制其他可引起心脏问题和卒中的危险因素（如肥胖，糖尿病，高胆固醇和高血压）。该指南还讨论了可能影响人们建立良好生活习惯的因素。
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.该指南强调健康的生活方式改变是预防心脏病的基石，并在最新研究的基础上提供实用的建议，从而更进一步。“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 说“无论是因为想看到我们的子孙长大成人，还是因为想要在年老时仍然保持活跃，当我们考虑想要更长寿、更健康的生活时，改善饮食和运动习惯都是非常重要的。”Some of the key lifestyle recommendations include: 一些主要的生活方式建议包括：· 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——我们回顾了地中海饮食，短跑饮食和素食饮食等特定饮食计划。提出，进食更多的蔬菜，水果，豆类，坚果，粗粮和鱼类，限制盐，饱和脂肪，油炸食品，加工肉类和甜味饮料的摄入。· 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.·定期锻炼——专家建议每周至少进行150分钟的中等强度运动，如快走，游泳，跳舞或骑自行车。对于那些不爱活动的人来说，有些活动总比没有活动要好，每天忙碌的生活中可以适当进行10分钟的高强度活动。目前，只有约一半的美国成人得到了足够的锻炼，长时间的坐着会抵消运动的好处。· 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.·达到和保持健康的体重——对于超重或肥胖的人来说，只要减掉5%-10%的体重（对于体重200磅的人来说，减掉10-20磅）就能显著降低他们患心脏病、卒中和其他健康问题的风险。· 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.·不吸烟也不吸入二手烟——心脏病死亡人数的1/3归因于吸烟或接触二手烟，因此应对每一个个体开展个体化的戒烟咨询并使用以批准上市的戒烟药物。
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.对于心脏病发作、卒中、心脏直视手术或放置支架以开通阻塞动脉的患者来说，阿司匹林可以挽救他们的生命。但是在健康人中常规使用阿司匹林来预防心脏病发作和卒中并没有那么明确的效益。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专家提供了基于科学的指导，即阿司匹林不应常规用于帮助那些没有已知心血管疾病的人预防心脏病和卒中。最近的研究表明，考虑到服用阿司匹林有较高的出血风险，而且事实上预防心脏病发作的证据不足，因此基于这些证据我们不建议阿司匹林常规用于病人的一级预防。“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说：“临床医生应该非常慎重地为没有心血管疾病的人开阿司匹林处方。与推荐阿司匹林相比，优化生活习惯、控制血压和胆固醇更为重要。阿司匹林应仅限于心血管疾病风险很高而出血风险低的人群。”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胆固醇指南，对于心血管疾病的一级预防，该指南提出，改善生活方式同时，应该对低密度脂蛋白胆固醇（LDL-C）水平升高（≥190mg/dl）、 2型糖尿病以及经临床医生-患者风险讨论后确定有足够的ASCVD风险的三类病人，推荐使用他汀类药物以预防心血管疾病的发生。
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严重的危险因素之一。有数据表明，钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂和胰高血糖素样肽-1受体（ GLP-1R）激动剂这两类降糖药物不仅能降血糖，同时能改善心血管获益。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心血管疾病一级预防指南》全文将同步发表在美国心脏协会《循环杂志》（Circulation）和《美国心脏病学会杂志》（JACC）。
