In Egypt and third world countries, there are no guidelines for prevention of atherosclerotic cardiovascular disease. Clinical guidelines developed in wealthy countries are inappropriate for most of the world population.

Guidelines address both lifestyle modification and drug therapy for established risk factors. Because of limited resources, thresholds of pharmacologic interventions for treatment of hypertension and hypercholesterolemia and target levels were higher than in western guidelines.

Two complimentary prevention strategies are needed. The first is directed to the whole population aiming at decreasing the risk profile of the whole community. The second is an individual approach targeting principally high risk individuals.

Individuals at increased risk of developing future cardiovascular events should be the first target of the prevention programs. High risk individuals include patients with established atherosclerotic cardiovascular disease (e.g. angina, MI, stroke), diabetic patients with additional risk factors, elderly individuals with risk factors, very high level of a single risk factor and multiple (> 3) risk factors.

Complete smoking cessation is mandatory through both community and individual approaches.

Both public and food industry should be aware of the hazards of unhealthy dietary style. A heart healthy diet should be made popular. This diet is low in animal fat and refined sugar and rich in fibers and unsaturated fat.
Increased consumption of fruits, vegetables, whole grain, legumes and fish should be encouraged. Food labeling, government legislations and media campaigns are important tools.

All individuals should be encouraged to establish and maintain at least 30 minutes of moderate intensity physical activity as 5 or more days/ week.

A normal body weight (BMI 20-25 Kg/m2) and a waist circumference < 94 cm in men and < 80 cm in women are recommended. Control of obesity requires indefinite dietary and behavior therapy and regular physical activity.
Combination of pharmacotherapy and lifestyle modification is more effective in weight loss than either approach alone.

Blood pressure goal < 140/90 mmHg is recommended in all individuals, lower levels may be required in high risk individuals. Accurate blood pressure measurements should be encouraged in all routine office visits.

Start of drug therapy for high BP, unless there is an emergency, should follow a period of monitoring and repeated measurements over a period varying from days to months depending upon BP level and global risk profile.

In patients with dyslipidemia an elevated serum LDL-C should be confirmed on at least two separate measurements. Initiation of statin therapy is recommended only after failure of dietary intervention for a period of 3-6 months and should take into consideration the level of LDL-C and the patient's global risk profile. The use of stains for primary prevention is not recommended unless LDL-C is > 210 mg/dl, or if LDL-C >160 mg/dl in presence of multiple risk factors.

Diagnosis of diabetes depends on accurate and repeated estimation of plasma glucose (PG). An optimal (normal) fasting PG is less than 100 mg/dl. If diet and exercise fail to normalize blood glucose within 3 months, oral therapy is initiated.
Screening for hyperglycemia is indicated for individuals most likely to have impaired glucose tolerance, those with established atherosclerotic cardiovascular disease, hypertension and dyslipidemia.