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
Treatme...
...commendations for ASCVD Prevention Efforts...
...nt-Centered Approaches to Comprehe...
...care approach is recommended for t...
...ed decision-making should guide discussions ab...
...cial determinants of health should info...
...ment of Cardiovascular Risk...
...s 40 to 75 years of age, clinicians should r...
...ults 20 to 39 years of age, it is reasonab...
...at borderline risk (5% to...
...dults at intermediate risk (≥7.5% to...
...20 to 39 years of age and for those 4...
...ple Considerations for Addressing Social De...
...-Enhancing Factors for Clinician–...
...ifestyle Factors Affecting Cardiovascular...
...ion and Diet...
...zing intake of vegetables, fruits, legumes, n...
...acement of saturated fat with dietary mon...
...diet containing reduced amounts of ch...
...a part of a healthy diet, it is reasonable...
As a part of a healthy diet, the intak...
...rcise and Physical Activity...
...ld be routinely counseled in healthcare visits to...
...lts should engage in at least 150 minutes pe...
...ults unable to meet the minimum physical ac...
...sedentary behavior in adults may be reasona...
...e 3. Definitions and Examples of Different Intensi...
...re 1. Hours Per Day Spent in Various States of...
...ors Affecting Cardiovascular Risk...
Adults With Overweight a...
...individuals with overweight and obes...
...nseling and comprehensive lifestyle inter...
...g body mass index (BMI) is recommende...
...e to measure waist circumference to ide...
Adults With Type 2 Diabetes Me...
...all adults with T2DM, a tailored n...
...with T2DM should perform at least 15...
...ith T2DM, it is reasonable to initiate metf...
...with T2DM and additional ASCVD risk fa...
...eatment of T2DM for Primary Prevention of Car...
...lts With High Blood Cho...
...t intermediate risk (≥7.5% to...
...diate risk (≥7.5% to...
...40 to 75 years of age with diabetes,...
...ts 20 to 75 years of age with an LDL-C leve...
...with diabetes mellitus who have multiple ASCVD...
...ediate-risk (≥7.5% to
...rmediate-risk (≥7.5% to...
...atients at borderline risk (5%...
...es-Specific Risk Enhancers That Are Independent...
...cted Examples of Candidates for Cor...
...3. Primary Prevention...
Table 6. Risk-Enhancing Factors for Cli...
...h Blood Pressure or Hypertension...
In adults with elevated blood pressure (BP) o...
...rage systolic BP (SBP) of 130 mm Hg...
...verage diastolic BP (DBP) of 80 mm Hg or...
...systolic BP (SBP) of 130 or less (I, B-R...
...diastolic BP (DBP) of 80 mm Hg or less (I,...
...e systolic BP (SBP) of 130 or less (I, B-R)57...
...e diastolic BP (DBP) of 80 mm Hg or less (...
...lic BP (SBP) of 130 or less (I, B-R)573...
...olic BP (DBP) of 80 mm Hg or less (I, C-EO)573...
...ults with an estimated 10-year ASCVD ris...
...systolic BP (SBP) of 130 or less (...
...ge diastolic BP (DBP) of 80 mm Hg or less (IIb,...
...d from recommendations in the 2017 Hyperten...
...4. BP Thresholds and Recommendations for Treat...
.... Best Proven Nonpharmacological Int...
...reatment of Toba...
...ould be assessed at every healthcare visit f...
To achieve tobacco abstinence, all adults wh...
...adults who use tobacco, a combination...
...adults who use tobacco, tobacco abstinence is r...
...facilitate tobacco cessation, it is reasona...
...ll adults and adolescents should av...
...Highlights of Recommended Behavioral and Phar...
...irin Use...
...ose aspirin (75–100 mg orally daily) mi...
...w-dose aspirin (75–100 mg orally daily)...
...spirin (75–100 mg orally daily) sho...