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...
...ching Recommendations for ASCVD Preven...
...ient-Centered Approaches to Comprehensive ASCVD P...
...sed care approach is recommended for the...
...on-making should guide discussions...
...ial determinants of health should info...
...ssessment of Cardiovascular Ri...
...to 75 years of age, clinicians shou...
...to 39 years of age, it is reasonable to assess...
...ts at borderline risk (5% to...
...ts at intermediate risk (≥7...
...lts 20 to 39 years of age and for those 40 to 59 y...
...le 1. Example Considerations for Addressing Soci...
...2. Risk-Enhancing Factors for Clinician–Pat...
...yle Factors Affecting Cardiovascular Risk...
...utrition and...
...zing intake of vegetables, fruits, legumes, nuts,...
...nt of saturated fat with dietary monounsatu...
...t containing reduced amounts of cholesterol and so...
...of a healthy diet, it is reasonable to min...
...of a healthy diet, the intake of trans...
...cise and Physical Activ...
...d be routinely counseled in healthcare visits to...
...s should engage in at least 150 minut...
...unable to meet the minimum physical activity reco...
...dentary behavior in adults may be re...
...3. Definitions and Examples of Different I...
...s Per Day Spent in Various States...
Other Factors Affecting Cardiovascular Ris...
...With Overweight and Obes...
...viduals with overweight and obesity, we...
...and comprehensive lifestyle interventions, i...
...g body mass index (BMI) is recommen...
...nable to measure waist circumference...
Adults With Type 2 Diabetes...
...all adults with T2DM, a tailored nutrition plan fo...
...should perform at least 150 minute...
...ts with T2DM, it is reasonable to initiate m...
...T2DM and additional ASCVD risk factors who requ...
...atment of T2DM for Primary Prevention of Cardiova...
...With High Blood Cholesterol
...intermediate risk (≥7.5% to
...iate risk (≥7.5% to...
...n adults 40 to 75 years of age with...
...ients 20 to 75 years of age with an LDL-...
In adults with diabetes mellitus wh...
...intermediate-risk (≥7.5% t...
In intermediate-risk (â...
In patients at borderline risk (5% t...
...le 4. Diabetes-Specific Risk Enhancers That Are In...
Table 5. Selected Examples of Candida...
.... Primary Preventio...
...able 6. Risk-Enhancing Factors for Clinicianâ€...
...gh Blood Pressure or Hypertension...
...h elevated blood pressure (BP) or hype...
an average systolic BP (SBP) of 130 mm Hg or hig...
...verage diastolic BP (DBP) of 80 mm Hg or higher...
...olic BP (SBP) of 130 or less (I, B-R)573...
...ge diastolic BP (DBP) of 80 mm Hg or less (I,...
...ystolic BP (SBP) of 130 or less (I, B-R)5...
...erage diastolic BP (DBP) of 80 mm Hg...
...stolic BP (SBP) of 130 or less (I, B-R)5...
an average diastolic BP (DBP) of 80 mm Hg or l...
...dults with an estimated 10-year ASCVD risk...
...systolic BP (SBP) of 130 or less (IIb...
...diastolic BP (DBP) of 80 mm Hg or l...
...m recommendations in the 2017 Hypertension Cl...
Figure 4. BP Thresholds and Recommendations f...
...t Proven Nonpharmacological Interventi...
Treatment of Tob...
...adults should be assessed at every healthcare...
...co abstinence, all adults who use toba...
...who use tobacco, a combination of behavioral in...
...n adults who use tobacco, tobacco a...
...facilitate tobacco cessation, it is...
...and adolescents should avoid secondhand smoke...
...able 8. Highlights of Recommended Beh...
...irin Use...
...ose aspirin (75–100 mg orally dail...
...pirin (75–100 mg orally daily) sh...
...-dose aspirin (75–100 mg orally d...