ACC, AHA release first cardiovascular disease primary prevention guideline



– The first medical society guideline to comprehensively address all facets of primary prevention of cardiovascular disease put special emphasis on a team-based approach that takes into account each person’s social determinants of health. The guideline substantially dialed down prior recommendations on aspirin for primary prevention by calling for no use in people older than 70 years and infrequent use in those 40-70 years old.

Mitchel L. Zoler/MDedge News

Dr. Donna K. Arnett

The American College of Cardiology and the American Heart Association released their 2019 guideline on the primary prevention of cardiovascular disease on March 17, during the annual meeting of the American College of Cardiology (J Amer Coll Cardiol. 2019 March 17;doi: 10.1016/j.jacc.2019.03.010.). The guideline is a “one-stop shop” that pulls together existing recommendations from the two organizations and combines it with some new recommendations that address issues such as aspirin prophylaxis, and the social setting of each person, said Donna K. Arnett, Ph.D., professor of epidemiology at the University of Kentucky, dean of the university’s College of Public Health, and co-chair of the guideline writing panel.

“We made the social determinants of health front and center. With many people, clinicians don’t ask whether they have access to healthy foods or a way to get to the pharmacy. Asking about these issues is step one,” toward helping people address their social situation, Dr. Arnett said while introducing the new guideline in a press briefing. The guideline recommends that clinicians assess the social determinants for each person treated for cardiovascular disease prevention using a screening tool developed by the U.S. Centers for Medicare & Medicaid Services and made available by the National Academy of Medicine (NAM Perspectives. 2017; doi:10.31478/201705b).

Primary prevention guideline: The top 10 takeaways

1. Most importantly, have a healthy lifestyle throughout life.
2. Use team-based care, and evaluate each person’s social determinants of health to inform management.
3. Perform a 10-year atherosclerotic cardiovascular disease risk estimation on adults age 75 years or younger.
4. Eat a healthy diet, and maintain normal weight.
5. Engage in physical activity.
6. Manage type 2 diabetes appropriately.
7. Stop smoking tobacco.
8. Use aspirin infrequently for primary prevention.
9. Use statin treatment appropriately to reduce risk and low-density lipoprotein cholesterol levels.
10. Manage blood pressure to recommended levels, generally less than 130/80 mm Hg.


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