Publication date: Nov 07, 2022 • 47 min ago • 3 min read • Join the discussion File photo: People go for a bike ride along the Trans Canada Trail in Ottawa’s west end. Photo by Ashley Fraser /Postmedia

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Exercise, good nutrition and healthy habits remain key to managing heart disease, according to an updated Canadian guideline. However, depression, which is closely related to cardiovascular disease, can interfere with treatment and healthy behaviors if left undetected.

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The guideline, released Monday, includes recommendations that people at risk of atherosclerotic heart disease be screened for depression. “Depression has a direct impact on cardiovascular outcomes and management.” Sign up to receive daily news headlines from the Ottawa Citizen, a division of Postmedia Network Inc. By clicking the subscribe button you consent to receive the above newsletter from Postmedia Network Inc. You can unsubscribe at any time by clicking the unsubscribe link at the bottom of our emails. Postmedia Network Inc. | 365 Bloor Street East, Toronto, Ontario, M4W 3L4 | 416-383-2300

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The guideline aims to harmonize recommendations from 11 different groups to make it easier for clinicians to manage their patients through informed treatment, screening and guidance, among other things. But patients themselves continue to hold some of the keys to reducing their risk and improving their health for a number of related diseases, says Dr. Peter Liu, chief scientific officer at the University of Ottawa Heart Institute and senior author of latest C-CHANGE (Canadian Cardiovascular Harmonized National Guideline Endeavour).

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“It doesn’t matter how wonderful the drugs are, nothing is as wonderful as exercise,” he said. The guideline also focuses on understanding and treating depression related to cardiovascular health. Published Monday in the Canadian Medical Association Journal, the guideline offers a more holistic approach to the care of patients with cardiovascular disease and related diseases, Liu said. “In medicine, we like to separate (care) into parts of the body,” he said. The updated guideline recognizes that treating patients is not just one organ at a time or one risk factor at a time, but more holistically. “Typical patients with multiple diseases require access to multiple guidelines at the same time, and some recommendations are not harmonized and often seem contradictory,” he said.

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Behavior-based recommendations have always been part of the guidance document. The latest – the first in four years – suggests that any exercise is better than none and recommends water as the drink of choice. It includes a recommendation of 30-60 minutes of moderate to vigorous physical activity most days of the week to achieve optimal health benefits, but notes that some activity is better than none. “Initiating physical activity at any level compared with remaining inactive provides the greatest increase in health benefits, and there are significant health benefits even at a lower volume or intensity of physical activity,” the guideline says. People who meet only half of the recommended activity levels still have a 14 percent lower risk of coronary heart disease than those who are inactive.

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“Therefore, rather than aiming for the maximum amount from the outset, clinicians should aim for whatever physical activity or exercise patients are willing to initiate, supporting them to create solutions to perceived barriers.” Liu said the new guidelines also recommend that people be active throughout the day, not exercise and then remain inactive for the rest of the day. The guidance includes recommendations for people with obesity, which is now recognized as a chronic disease, including evidence that walking an average of 45 minutes four times a week at moderate intensity leads to weight loss, reduced BMI and reduced waist circumference. The guideline contains 83 recommendations and is described in the medical journal as a one-stop guideline that “takes a 360-degree approach to the management of heart disease in Canadian patients.” Half of the suggestions are new or updated since the last version four years ago.

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Dr. Rahul Jain, C-CHANGE co-chair and family physician at Sunnybrook Health Sciences Centre, noted that since the last guidance document there have been many new evidence-based recommendations, from changes in medication management to new thresholds for lipid levels in secondary prevention . “We hope this resource helps primary care clinicians stay up-to-date with many constantly evolving cardiovascular guidelines so their patients get the best possible care.” The document is located at:

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