CVD Primary Prevention Guidelines: 10 key points for the busy practitioner.
ASCVD is the global leader in morbidity and mortality.
The American College of Cardiology and the American Heart Association believe much of this is preventable. They recently released guidelines for primary prevention of CVD for that purpose. Kameswari Maganti, MD, FACC provided expert analysis and summarized 10 key points in an American College of Cardiology article.
10 Key Practice Messages from 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease
- Promoting a healthy lifestyle is the most important way to prevent ASCVD, heart failure, and atrial fibrillation.
- Team-based care is effective to prevent CVD. Social determinants of health should be considered.
- Adults 40-75 years of age should be consulted on their ASCVD risk estimation before starting on pharmacological therapy.
- Emphasizes diets with higher intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimize the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. Counseling on restricted calorie diets are suggested for overweight and obese adults.
- Achieve 150 minutes of accumulated moderate-intensity physical activity per week or 75 minutes of vigorous activity.
- For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.
- Every adult assessed every healthcare visit for tobacco use. Strongly recommend quitting and offer assistance.
- Aspirin has a greater risk than benefit. It should be used infrequently.
- Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol (LDL-C) levels (≥190 mg/dL), those with diabetes mellitus who are 40-75 years of age, and those determined to be at sufficient ASCVD risk after a clinician-patient risk discussion.
- All adults with elevated blood pressure should be recommended nonpharmacological interventions. The target for those on pharma therapy should generally be <130/80 mmHg.
ACC.org- Key Points From the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease by Kameswari Maganti, MD, FACC
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;Mar 17: