ACC, AHA release first cardiovascular disease primary prevention guideline



“No other guideline has highlighted the social determinants of health,” noted Erin D. Michos, MD, associate director of preventive cardiology at Johns Hopkins Medicine in Baltimore, and a member of the guideline-writing panel. Other overarching themes of the guideline are its emphasis on the need for a team of clinicians to deliver all the disparate and time-consuming facets of care needed for comprehensive primary prevention of cardiovascular disease, and its call for a healthy lifestyle throughout life as foundations for prevention, Dr. Michos said in an interview.

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With 48 recommendations, the guideline also deals with prevention issues such as a healthy diet and body mass, appropriate control of diabetes, smoking cessation, and control of blood pressure and cholesterol (see chart). The writing committee took the cholesterol and blood pressure recommendations directly from recent guidelines from the ACC and AHA in 2017 (blood pressure:J Amer Coll Cardiol. 2018 May;71[19]:e177-e248) and 2018 (cholesterol:Circulation. 2018 Nov 10;doi: 10.1161/CIR.0000000000000625).

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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