Primary Prevention of Cardiovascular Disease

A team-based care approach is recommended for the control of risk factors associated with ASCVD. (I, A)

Shared decision-making should guide discussions about the best strategies to reduce ASCVD risk. (I, B-R)

Social determinants of health should inform optimal implementation of treatment recommendations for the prevention of ASCVD. (I, B-NR)

For adults 40 to 75 years of age, clinicians should routinely assess traditional cardiovascular risk factors and calculate 10-year risk of ASCVD by using the pooled cohort equations (PCE). (I, B-NR)

For adults 20 to 39 years of age, it is reasonable to assess traditional ASCVD risk factors at least every 4 to 6 years. (IIa, B-NR)

In adults at borderline risk (5% to <7.5% 10-year ASCVD risk) or intermediate risk (≥7.5% to <20% 10-year ASCVD risk), it is reasonable to use additional risk-enhancing factors to guide decisions about preventive interventions (e.g., statin therapy). (IIa, B-NR)

In adults at intermediate risk (≥7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10-year ASCVD risk), if risk-based decisions for preventive interventions (e.g., statin therapy) remain uncertain, it is reasonable to measure a coronary artery calcium score to guide clinician–patient risk discussion. (IIa, B-NR)

For adults 20 to 39 years of age and for those 40 to 59 years of age who have <7.5% 10-year ASCVD risk, estimating lifetime or 30-year ASCVD risk may be considered. (IIb, B-NR)