Key Targets for CVD Prevention

• Blood Pressure:

  • Targets for the Apparently Healthy Population
  • Overall goal is:
  • Optimal is 120 - 129/70 - 79 mmHg
  • less than 140/90 mmHg
  • In people with Hypertension, Diabetes, High/Very High Risk of CVD or with established CVD on treatment
  • 120 - 129/70 - 79 mmHg
  • Lower the better if asymptomatic
• Blood Lipids:

  • General Healthy Population
  • TC less than 5 mmol/l
  • LDL less than 3 mmol/l
  • HDL (males) more than 1 mmol/l
  • HDL (females) more than 1.2 mmol/l
  • TG less than 1.7 mmol/l
  • Non-HDL less than 4 mmol/l
  • Low to Moderate CVD Risk
  • LDL-C less than 2.6 mmol/l
  • Non-HDL less than 3.4 mmol/l
  • HDL and TG as per general guidelines
  • High Risk and Uncomplicated DM
  • LDL-C less than 1.8 mmol/l
  • Non-HDL less than 2.6 mmol/l
  • HDL and TG as per guidelines
  • Very High Risk/People with CVD/those with Diabetes and TOD
  • LDL-C less than 1.4 mmol/l
  • Non-HDL less than 2.2 mmol/l
  • HDL and TG as per guidelines
• Blood Glucose - People without Diabetes:

  • Fasting Blood Glucose (FBG)
  • FBG should be less than 5.5 mmol/l in a person without diabetes
  • Where FBG is 5.5 to 6.9 mmol/l this could indicate “Pre-Diabetes”
  • Where FBG is 7 mmol/l or more this could indicate a diagnosis of Diabetes
  • Random Blood Glucose should be less than 11.1 mmol/l in people without diabetes or pre-diabetes
• Blood Glucose - Adults WITH Diabetes:

  • Random Blood Glucose
  • A person with known diabetes should be under management to control blood glucose levels and avoid sustained periods of hyperglycaemia
  • When stable usually the random glucose levels will be:
  • Before meals: 4 to 7 mmol/L for people with type 1 or type 2 diabetes
  • After meals: under 9 mmol/L for people with type 1 diabetes and under 8.5 mmol/L for people with type 2 diabetes
• HbA1c - People without Diabetes:

  • In those without diabetes, HbA1c should be less than 42 mmol/mol (less than 6%)
  • Where there is the presence of Pre-Diabetes the HbA1c will be between 42 and 47 mmol/mol (6.0 - 6.4%)
  • An HbA1c greater than 48 mmol/mol (6.5% and over) could indicate the presence of diabetes
• HbA1c - Adults WITH Diabetes:

  • In people with diabetes the aim is reach the desirable level for HbA1c which is 48 mmol/mol (6.5%)
  • However, overall trying to keep people with diabetes between 48 - 58 mmol/mol (6.5 – 7.5 %)
• Lifestyle Risk Factor Targets:

  • Smoking:
  • No exposure to tobacco in any form
  • People who have heart or respiratory diseases, and those who live with them, should be made aware of the risks of both active and passive smoking
• Lifestyle Risk Factor Targets:

  • Physical Activity:
  • 150 minutes – 300 minutes per week of moderate aerobic PA or 75 - 150 minutes a week of vigorous aerobic PA or a combination thereof
  • Avoidance of prolonged sedentary behaviour
  • Muscle strengthening activities performed on at least two occasions per week
• Lifestyle Risk Factor Targets:

  • BMI:
  • White European populations the target BMI is 18.5 – 25 kg/m^2
  • Remember that 25 – 29.9 kg/m^2 would indicate increased risk and more then 30 kg/m^2 would indicate high risk
  • Asian populations the target BMI is 18.5 – 22.9 kg/m^2
  • Remember that 23 – 27.5 kg/m^2 would indicate increased risk and 27.5 kg/m^2 and above would indicate high risk
• Lifestyle Risk Factor Targets:

  • Waist Circumference:
  • Target of less than 94 cm for European and Sub-Saharan Africans men
  • Target of less than 90 cm for South Asian, Chinese, Japanese, Ethnic South and Central American men
  • Target of less than 80 cm for all women
• Lifestyle Risk Factor Targets:

  • Diet:
  • Intake of saturated fat to less than 10% of total fat intake (preferably in lean meat and low fat dairy products)
  • Replace saturated fat with polyunsaturated fat where possible
  • Consume five portions per day of fruit and vegetables
  • Consume at least one serving of fish per week
  • Consider regular consumption of whole grains and nuts
  • Keep salt consumption to less than 5 g/day
  • Limit alcohol intake to less than 100 grams week
• Lifestyle Risk Factor Targets:

  • Diet:
  • Avoid/reduce consumption of:
  • Processed meats or commercially produced foods which tend to be high in salt and trans fatty acids (TFA)
  • Refined carbohydrates, such as white bread, processed cereals
  • Sugar sweetened beverages
  • Calorie rich, but nutritionally poor, snacks such as sweets, cakes, and crisps
• Waist Circumference and BMI Targets related to ethnicity:

  • Waist European males = 85 cm
  • Waist Europeans females = 87 cm
  • Waist South Asian males = 91 cm
  • Waist Japanese males = 95 cm
  • Waist European males = 104 cm
  • Waist South Asian females = 81 cm
  • Waist Chinese females = 89 cm
  • BMI European males = 31 kg.m^2
  • BMI Asian males = 23 kg.m^2