Attention to Healthy Lifestyle at an Early Age Key to Preventing Heart Disease

By Reuters Staff

May 29, 2019

NEW YORK (Reuters Health) - Updated clinical practice guidelines on the management of blood cholesterol encourage adopting a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD), according to a new report.

The 78-page guideline from the American Heart Association (AHA), the American College of Cardiology (ACC) and other national associations was published in Circulation in November. To help disseminate the recommendations, Dr. Scott Grundy of the University of Texas Southwestern Medical Center in Dallas and colleagues now provide a six-page synopsis, published online May 27 in the Annals of Internal Medicine.

As a commentary ( released with the guidelines in November noted, "Ultimately, the value of a guideline is determined by how effectively it is implemented into practice and by how much morbidity and mortality are avoided through its application."

In addition to maintaining a healthy lifestyle over the lifespan, a theme stressed throughout the guideline, it advises:

- Maximally tolerated doses of statins in secondary prevention of ASCVD.

- Nonstatin medications (ezetimibe or pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors) in addition to statin therapy for patients at very high risk for ASCVD.

- Statin therapy without risk stratification in severe primary hypercholesterolemia, often starting in childhood.

- Moderate-intensity statin therapy without risk stratification in adults aged 40 to 75 years with diabetes and an LDL cholesterol (LDL-C) level of 1.8 mmol/L (70 mg/dL) or higher.

- A risk discussion between the provider and patient about statin therapy for adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.

- Moderate-intensity statin therapy if a risk discussion favors their use in adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL) and a 10-year ASCVD risk of 7.5% or higher.

- A three-tiered decision-making process in primary prevention in adults aged 40 to 75 years to personalize the risk decision. This includes enhancing factors such as family history of premature coronary artery disease metabolic syndrome, chronic kidney disease, LDL-C level 160 mg/dL or higher; and in women, history of pre-eclampsia or premature menopause (< 40 years); inflammatory diseases such as psoriasis, rheumatoid arthritis, HIV), and high-risk ethnicity such as South Asian ancestry.

- Coronary-artery-calcium scoring to improve risk stratification in moderate-risk patients for whom the benefits of statin therapy are uncertain.

- Follow-up for adherence to medications and lifestyle and to assess adequacy of response.

According to the Centers for Disease Control and Prevention, cardiovascular disease is the number one cause of death in the United States, including for African-American, Hispanic, and white persons and for both women and men.

The leading cause of death attributable to cardiovascular disease is coronary heart disease (44%), followed by stroke (17%). In 2013-2014, ASCVD accounted for 14% of total health expenditures, more than any other major diagnostic group.


Ann Intern Med 2019.