Primary Prevention of Cardiovascular Disease
Key Points
Key Points
- The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.
- A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.
- Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. In addition, assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.
- All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
- Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical 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.
- All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.
- Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.
- Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, those who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.
- Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.
Treatment
...atment...
...ecommendations for ASCVD Prevention Efforts...
...ent-Centered Approaches to Comprehensive ASCVD P...
...eam-based care approach is recommended for the...
...decision-making should guide discussi...
...eterminants of health should inform op...
...t of Cardiovascular Risk...
...r adults 40 to 75 years of age, clinicians should...
...0 to 39 years of age, it is reasonab...
...at borderline risk (5% to...
...ts at intermediate risk (≥7.5%...
...adults 20 to 39 years of age and for those 40 t...
.... Example Considerations for Addressing Social...
...nhancing Factors for Clinician–Patient Risk D...
...festyle Factors Affecting Cardiovascular Ri...
...utrition and D...
...emphasizing intake of vegetables, fruits,...
...of saturated fat with dietary mon...
...ntaining reduced amounts of cholesterol a...
...a healthy diet, it is reasonable to minimiz...
...a part of a healthy diet, the intake of trans fa...
...xercise and Physical Act...
...should be routinely counseled in health...
...engage in at least 150 minutes per week...
...dults unable to meet the minimum physical...
...reasing sedentary behavior in adults may be reason...
...ions and Examples of Different Intens...
Figure 1. Hours Per Day Spent in Various States of...
...er Factors Affecting Cardiovascul...
...lts With Overweight and Obesit...
...iduals with overweight and obesity, weight lo...
...ounseling and comprehensive lifestyle intervent...
...y mass index (BMI) is recommended annually or mo...
...reasonable to measure waist circumfer...
...ults With Type 2 Diabetes Melli...
...ults with T2DM, a tailored nutrition plan focusing...
...DM should perform at least 150 minutes...
...with T2DM, it is reasonable to initiate metf...
...th T2DM and additional ASCVD risk fa...
...Treatment of T2DM for Primary Prevention of C...
...ts With High Blood Cholestero...
In adults at intermediate risk (≥7.5%...
In intermediate risk (≥7.5% to...
...n adults 40 to 75 years of age with diabetes, re...
...o 75 years of age with an LDL-C level of 19...
...ts with diabetes mellitus who have multiple AS...
...ermediate-risk (≥7.5% to...
...iate-risk (≥7.5% to...
...ts at borderline risk (5% to...
...4. Diabetes-Specific Risk Enhancers That Are Inde...
.... Selected Examples of Candidates for Coronary Art...
Figure 3. Primary Prevention
...able 6. Risk-Enhancing Factors for Clinician...
Adults With High Blood Pressure or Hype...
...h elevated blood pressure (BP) or...
...tolic BP (SBP) of 130 mm Hg or higher (I, A)573...
...rage diastolic BP (DBP) of 80 mm Hg or higher, (...
...systolic BP (SBP) of 130 or less (I, B...
an average diastolic BP (DBP) of 80 mm Hg or les...
...age systolic BP (SBP) of 130 or less (I, B-R)57...
...olic BP (DBP) of 80 mm Hg or less (I, C-EO...
...stolic BP (SBP) of 130 or less (I, B-R)573...
an average diastolic BP (DBP) of 80 mm...
...with an estimated 10-year ASCVD risk...
...stolic BP (SBP) of 130 or less (IIb, B-NR...
...ge diastolic BP (DBP) of 80 mm Hg or...
...om recommendations in the 2017 Hypert...
...re 4. BP Thresholds and Recommendation...
...Proven Nonpharmacological Interventions for Prev...
...eatment of Tobacco Us...
All adults should be assessed at every healthca...
...bacco abstinence, all adults who use tob...
...e tobacco, a combination of behavioral...
In adults who use tobacco, tobacco abst...
...acilitate tobacco cessation, it is r...
...and adolescents should avoid secon...
...8. Highlights of Recommended Behavioral and P...
Aspirin U...
Low-dose aspirin (75–100 mg orally daily) might...
...rin (75–100 mg orally daily) should NOT be...
...aspirin (75–100 mg orally daily) should NOT b...