UA/NSTEMI

Weight Management ÎÎWeight management, as measured by body mass index and/or waist circumference, should be assessed on each visit. A body mass index of 18.5-24.9 kg/m2 and a waist circumference (measured horizontally at the iliac crest) of <40 inches for men and <35 inches for women is recommended. (I-B) ÎÎAdditional weight management practices recommended include the following: •  On each patient visit, it is useful to consistently encourage weight maintenance/ reduction through an appropriate balance of physical activity, reduced caloric intake, and formal behavioral programs when indicated to maintain/achieve a body mass index between 18.5 and 24.9 kg/m2. (I-B) •  If waist circumference is ≥35 inches in women or ≥40 inches in men, it is beneficial to initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated. (I-B) •  The initial goal of weight loss therapy should be to reduce body weight by approximately 10% from baseline. With success, further weight loss can be attempted if indicated through further assessment. (I-B) Smoking Cessation ÎÎDiscontinue smoking and avoid exposure to environmental tobacco smoke at work and home. Follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement) is useful, as is adopting a stepwise strategy aimed at smoking cessation (the 5 As are: Ask, Advise, Assess, Assist, and Arrange). (I-B) Physical Activity ÎÎThe patient's risk after UA/NSTEMI should be assessed on the basis of an in-hospital determination of risk. A physical activity history or an exercise test to guide initial prescription is beneficial. (I-B) ÎÎGuided/modified by an individualized exercise prescription, patients recovering from UA/NSTEMI generally should be encouraged to achieve physical activity duration of 30-60 min/d, preferably 7 (but ≥5) days per week of moderate aerobic activity, such as brisk walking, supplemented by an increase in daily lifestyle activities (eg, walking breaks at work, gardening, and household work). (I-B) ÎÎCardiac rehabilitation/secondary prevention programs are recommended for patients with UA/NSTEMI, particularly those with multiple modifiable risk factors and/or those moderate- to highrisk patients in whom supervised exercise training is particularly warranted. (I-B) ÎÎThe expansion of physical activity to include resistance training on 2 days per week may be reasonable. (IIb-C) 39

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