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
...eatment
...rching Recommendations for ASCVD Prevent...
...-Centered Approaches to Comprehensi...
...team-based care approach is recommende...
Shared decision-making should guide discussions...
...ocial determinants of health should...
...t of Cardiovascular Risk...
...to 75 years of age, clinicians should routinely a...
...adults 20 to 39 years of age, it is...
...t borderline risk (5% to...
...dults at intermediate risk (≥7.5...
...o 39 years of age and for those 40 to 59 years o...
...e 1. Example Considerations for Addr...
...able 2. Risk-Enhancing Factors for Clin...
...Factors Affecting Cardiovascular R...
...rition and Diet...
...asizing intake of vegetables, fruits, legumes, nu...
...ent of saturated fat with dietary monounsatura...
...iet containing reduced amounts of chol...
...healthy diet, it is reasonable to...
...rt of a healthy diet, the intake of trans...
...and Physical Activity
...ould be routinely counseled in healthcare vis...
...ngage in at least 150 minutes per week of a...
...or adults unable to meet the minimum physical...
...g sedentary behavior in adults may be reas...
.... Definitions and Examples of Different Intensiti...
...s Per Day Spent in Various States of...
...ctors Affecting Cardiovascular Risk...
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...dividuals with overweight and obesity, weight...
...eling and comprehensive lifestyle interv...
...ody mass index (BMI) is recommended an...
...asonable to measure waist circumference t...
...ith Type 2 Diabetes Mell...
...ults with T2DM, a tailored nutriti...
...th T2DM should perform at least 150 minutes pe...
...or adults with T2DM, it is reasonable to...
...lts with T2DM and additional ASCVD risk factor...
...2. Treatment of T2DM for Primary Prevention of...
...dults With High Blood Cholesterol...
...intermediate risk (≥7.5% t...
...n intermediate risk (≥7.5...
...adults 40 to 75 years of age with...
...o 75 years of age with an LDL-C level of 190 mg/d...
...dults with diabetes mellitus who have multip...
...rmediate-risk (≥7.5% to...
...ntermediate-risk (≥7.5% to...
...at borderline risk (5% to...
...4. Diabetes-Specific Risk Enhancers That Are Inde...
.... Selected Examples of Candidates for...
Figure 3. Primary Preve...
...6. Risk-Enhancing Factors for Clinician–Pa...
...With High Blood Pressure or Hyperte...
...adults with elevated blood pressure (BP) o...
an average systolic BP (SBP) of 130 mm Hg or h...
...verage diastolic BP (DBP) of 80 mm Hg or...
...average systolic BP (SBP) of 130 or less...
...ge diastolic BP (DBP) of 80 mm Hg or less (I, C-E...
...e systolic BP (SBP) of 130 or less (I, B-R)...
...age diastolic BP (DBP) of 80 mm Hg...
an average systolic BP (SBP) of 130...
...diastolic BP (DBP) of 80 mm Hg or less (...
...n adults with an estimated 10-ye...
...ge systolic BP (SBP) of 130 or less (IIb, B-...
...rage diastolic BP (DBP) of 80 mm Hg or less (IIb,...
...recommendations in the 2017 Hypert...
.... BP Thresholds and Recommendations for Trea...
...oven Nonpharmacological Interventions for Preven...
...tment of Tobacco...
...adults should be assessed at every hea...
...achieve tobacco abstinence, all adults who...
...ho use tobacco, a combination of behavior...
...adults who use tobacco, tobacco abst...
...tate tobacco cessation, it is reasonable t...
...l adults and adolescents should avoid secondhan...
...hlights of Recommended Behavioral and...
...spirin Us...
...in (75–100 mg orally daily) might be conside...
...ow-dose aspirin (75–100 mg orally daily) sh...
...rin (75–100 mg orally daily) should NOT...