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Never enough recommended. Beyond the AHA/ACC guideline on lifestyle and behavior for cardiovascular prevention

Published:October 31, 2019DOI:https://doi.org/10.1016/j.ejim.2019.10.021
      “An apple a day keeps the doctor away”. But the saying seems true even once the doctor already did his job. The recent AHA/ACC guidelins on the primary prevention of cardiovascular diseases [
      • Arnett D.K.
      • Khera A.
      • Blumenthal R.S
      ACC/AHA guideline on the primary prevention of cardiovascular disease: Part 1, lifestyle and behavioral factors.
      ] and convincing new clinical studies on mortality reduction with physical activity in patients with and without cardiovascular disease (CVD) [
      • Jeong S.W.
      • Kim S.H.
      • Kang S.H.
      • Kim H.J.
      • Yoon C.H.
      • Youn T.J.
      • Chae I.H
      Mortality reduction with physical activity in patients with and without cardiovascular disease.
      ] are imposing a view conferring to lifestyle and behavior interventions the dignity of a measure not inferior to the pharmacological one and free of any harm. Yet even in western countries the optimal use of these resources is far away due to barriers being largely of a cultural nature. The Euroaspire III [
      • Kotseva K.
      • Wood D.
      • De Backer G.
      • De Bacquer D.
      • Pyörälä K.
      • Reiner Z.
      • Keil U.
      EUROASPIRE Study Group. EUROASPIRE III
      Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries.
      ] and V studies [
      • Kotseva K.
      • De Backer G.
      • De Bacquer D.
      • Rydén L.
      • Hoes A.
      • Grobbee D.
      • Maggioni A.
      • Marques-Vidal P.
      • Jennings C.
      • Abreu A.
      • Aguiar C.
      • Badariene J.
      • Bruthans J.
      • Castro Conde A.
      • Cifkova R.
      • Crowley J.
      • Davletov K.
      • Deckers J.
      • De Smedt D.
      • De Sutter J.
      • Dilic M.
      • Dolzhenko M.
      • Dzerve V.
      • Erglis A.
      • Fras Z.
      • Gaita D.
      • Gotcheva N.
      • Heuschmann P.
      • Hasan-Ali H.
      • Jankowski P.
      • Lalic N.
      • Lehto S.
      • Lovic D.
      • Mancas S.
      • Mellbin L.
      • Milicic D.
      • Mirrakhimov E.
      • Oganov R.
      • Pogosova N.
      • Reiner Z.
      • Stöerk S.
      • Tokgözoğlu L.
      • Tsioufis C.
      • Vulic D.
      • Wood D.
      EUROASPIRE Investigators
      Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European society of cardiology esc-eorp euroaspire V registry.
      ] have dramatically demonstrated in subjects still free from cardiovascular disease that physical activity is practiced by no more than 20%; 17% currently smoke and 35% are obese but also the majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity. Poor patient awareness of the benefits of a healthy lifestyle but also insufficient action from doctors for their patients in following the right approach are still important barriers [
      • Duclos M.
      • Dejager S.
      • Postel-Vinay N.
      • di Nicola S.
      • Quéré S.
      • Fiquet B
      Physical activity in patients with type 2 diabetes and hypertension–insights into motivations and barriers from the mobile study.
      ,
      • Lanhers C.
      • Duclos M.
      • Guttmann A.
      • Coudeyre E.
      • Pereira B.
      • Ouchchane L
      General practitioner barriers to prescribe physical activity: The dark side of the cluster effects on the physical activity of their type 2 diabetes patients.
      ]. And this is all the more serious the more clearly the benefit of healthy living habits emerges with the guidelines that are defining better and better how to adopt them.

      Keywords (MeSH)

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