What are the ACC/AHA guidelines on the primary prevention of cardiovascular disease?

Updated: Dec 23, 2019
  • Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Answer

Answer

In September 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) published joint guidelines on the primary prevention of cardiovascular disease. [18]

It is recommended that atherosclerotic cardiovascular disease (ASCVD)–related risk factors be controlled via a team-based approach.

For adults, health-care visits should routinely include counseling on optimization of a physically active lifestyle.

At least 150 minutes per week of accumulated moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity (or an equivalent combination of moderate and vigorous activity) is recommended for ASCVD risk reduction in adults.

Improvement of the ASCVD risk factor profile through weight loss is recommended for patients with overweight or obesity.

It is recommended that adults with overweight or obesity achieve and maintain weight loss with the aid of counseling and comprehensive lifestyle interventions (including calorie restriction).

Improvement of glycemic control, achievement of weight loss (if necessary), and improvement of other ASCVD risk factors, via a tailored nutrition plan aimed at providing a heart-healthy dietary pattern, is recommended for all adults with type 2 diabetes mellitus (T2DM).

Improvement of glycemic control, achievement of weight loss (if necessary), and improvement of other ASCVD risk factors, via at least 150 minutes per week of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity, is recommended for adults with T2DM.

If, as a result of a risk discussion, a decision is made to employ statin therapy, adults with high blood cholesterol with an intermediate ASCVD risk (≥7.5% to < 20% 10-year ASCVD risk) should be treated with a moderate-intensity statin.

In patients with high blood cholesterol who have an intermediate ASCVD risk (≥7.5% to < 20% 10-year ASCVD risk), reduction of low-density lipoprotein cholesterol (LDL-C) levels by at least 30% is recommended, while optimal ASCVD risk reduction can be targeted, particularly in high-risk patients (≥20% 10-year ASCVD risk), by reducing LDL-C levels by at least 50%.

Maximally tolerated statin therapy is recommended in patients aged 20-75 years with an LDL-C level of at least 190 mg/dL (≥4.9 mmol/L).

Among the nonpharmacologic interventions recommended for adults with elevated blood pressure (BP) or hypertension, including patients who need antihypertensive agents, are the following:

  • Weight loss

  • A heart-healthy dietary pattern

  • Sodium reduction

  • Dietary potassium supplementation

  • Increased physical activity with a structured exercise program

  • Limited alcohol

Primary prevention of cardiovascular disease (CVD) with BP-lowering medications is recommended for adults with an estimated 10-year ASCVD risk of at least 10% and an average systolic BP (SBP) of 130 mm Hg or higher or an average diastolic BP (DBP) of at least 80 mm Hg.

A BP target of below 130/80 mm Hg is recommended for adults with confirmed hypertension and a 10-year ASCVD event risk of at least 10%.

Treatment to a BP goal of below 130/80 mm Hg is recommended for adults with hypertension and chronic kidney disease.

Antihypertensive drug treatment should be administered to adults with T2DM and hypertension who have a BP of 130/80 mm Hg or higher, the aim being to reduce BP to below 130/80 mm Hg.

For adults, cessation of tobacco use should be facilitated by evaluation of such use at every health-care visit, with the status of a patient’s tobacco use recorded as a vital sign.

All adult tobacco users should be advised to quit.

In adult tobacco users, quit rates should be maximized by combining behavioral interventions with pharmacotherapy.

For more information, please go to Cardiovascular Disease Primary Prevention/Lifestyle Guidelines.


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