When a stroke patient with symptomatic intracranial stenosis has been worked up, we SAMMPRIS him, by which we mean ASS, Clopidogrel and high dose statin. This is, of course, not the whole story – more important than drugs are the necessary lifestyle adjustments. We use this example to develop a system for stepwise improvement of risk factors and health behaviour.
In my view, the standard risk factors (pressure, sugar, fat and weight) can all be improved by concentrating on the simple three:
- Get active and work out
- Eat healthy
- Don’t smoke
This sounds reasonable, although the science behind 1 and 2 is not so simple. Just staying active (e.g. walking every day for at least 30 mins or running for 3 x 25 mins) might be healthy but need not really lower your blood pressure. Vastly more efficient are more intense workouts such as muscle strengthening (resistance) exercises or even high intensity interval training. The evidence for these measures is quite good. With regard to healthy eating, there seems to be no golden way to a good diet (in fact, most diets studied have been harmful), yet the mere fact that you are trying to be conscious about your food has a proven health promoting effect.
The current decade is probably the best to initiate health promoting behaviour, as smartphone/smartwatch/fitness bands abound and make it easier to watch your health without investing too much time. In particular these applications
- can help to find out what improves weight or fitness
- introduce a gamification factor to the otherwise boring issue
- might lead to more insight about how your blood pressure, sugar or cholesterol react to specific measures
- might allow to identify those patients where high dose statins are harmful by reducing fitness effects
- AHA’s life’s simple 7 pages are a bit confusing, but contain very reasonable and simple goals, that you can work on with your patients
- The german society of nutrition (Deutsche Gesellschaft für Ernährung) has a very simple Rule of 10 for eating healthy, that I give to my patients
- A brain teaser for thinking about when statins could be harmful
- There is a whole issue of the Can J Cardiol that is concerned with exercise for health improvement