The short slide show summarizes 9 pearls on preventive cardiology from the landmark ACC/AHA 2019 guideline on primary CVD prevention.
Atherosclerotic cardiovascular disease (ASCVD) outcomes have improved substantially in recent years, but ASCVD remains the leading cause of morbidity and mortality worldwide.
The 2019 landmark clinical practice guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) provide evidence-based recommendations for primary prevention of ASCVD.
For a concise summary of key points, scroll through the slides below.
HEALTHY LIFESTYLE, TEAM-BASED APPROACH. ACC/AHA: The best approach to preventing atherosclerotic vascular disease, heart failure, and atrial fibrillation is promoting a healthy lifestyle.
HEARTY FOOD RECOMMENDATIONS. ACC/AHA recommends that primary care clinicians promote a diet rich in vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and that minimizes consumption of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages.
EXERCISE COUNTS. There is a strong inverse dose-response relationship between amount of moderate-vigorous physical activity and incident ASCVD events and death. ACC/AHA recommends some moderate-vigorous intensity exercise, even if not at recommended levels.
OVERWEIGHT, OBESITY BALANCING ACT. Obesity nutrition efforts revolve around balancing caloric intake with caloric expenditure; counseling also is highly recommended. Advise overweight/obese adults to participate in comprehensive lifestyle programs of ≥6 mos duration that assist with adherence to a low-calorie diet and increased physical activity.
DIABETES REQUIRES LIFESTYLE CHANGES, DRUGS. A heart-healthy dietary pattern plus moderate physical activity are key interventions; help improve glycemic control, achieve weight loss. Metformin is first-line drug therapy, with lifestyle change. When a second agent is needed, anSGLT2 inhibitor or GLP-1 receptor agonist may improve A1c and reduce ASCVD risk.
TOBACCO TROUBLES. Tobacco use is the leading preventable cause of disease, disability, and death in the United States. ACC/AHA recommends that primary care clinicians assess all adults for tobacco use at every health care visit; those who do use tobacco should be assisted and strongly advised to quit. Provide a combination of behavioral intervention plus medication.
AVOID ASPIRIN. Use of aspirin is well established for secondary prevention but controversial in primary prevention because persons with no prior ASCVD are less likely to have future events and the risk of bleeding is evidence-based. Recommendation: Aspirin should be used infrequently in routine primary prevention of ASCVD because of lack of net benefit.
STATIN USE DEPENDS ON RISK LEVEL. Statin therapy is first-line treatment for: Primary prevention of ASCVD in patients who have elevated LDL-C levels (≥190 mg/dL) and for patients aged 40 to 75 years who have T2D and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.
HYPERTENSION INTERVENTIONS. Hypertension accounts for more ASCVD deaths in the US than any other modifiable ASCVD risk factor. Nonpharmacologic interventions are recommended for all adults with hypertension. For patients who require pharmacologic therapy, the target blood pressure generally should be <130/80 mm Hg.