2019 CVD Primary Prevention Guideline: 5 Things to Know

Erin D. Michos, MD, MHS; Andi Shahu, MD, MHS


December 11, 2019

Editorial Collaboration

Medscape &

Although cardiovascular disease (CVD) is one of the leading causes of death worldwide,[1] most patients with CVD have one or more modifiable risk factors.[2] To enhance patient care and lower the prevalence and incidence of CVD, the American College of Cardiology (ACC) and American Heart Association (AHA) published concise guideline recommendations for the primary prevention of CVD.[3]

The guideline addresses and provides updated recommendations in the following nine topic areas: risk assessment, aspirin, cholesterol, blood pressure, diabetes, nutrition/diet, physical activity, obesity, and smoking. The joint ACC/AHA task force included recently published recommendations for the management of cholesterol[4] and blood pressure,[5] and provided new recommendations on physical activity/exercise, diet, aspirin, diabetes management, weight management, and tobacco cessation.[3]

Here are five things to know about primary CVD prevention.

1. A comprehensive, patient-centered approach is essential to CVD prevention.

The three elements of utmost importance to patient-centered CVD prevention are a team-based approach, shared decision-making, and social determinants of health.

A team-based approach to care requires collaboration between multidisciplinary healthcare professionals (eg, physicians, nurses, pharmacists) and patients and their family members or caregivers. Studies have shown that a team-based approach to care results in greater CVD risk reduction than a non–team-based approach.[6]

The second element, shared-decision making, is reliant on successful clinician-patient discussions concerning the individual patient's CVD risk, potential benefits of lifestyle and drug therapy for CVD risk reduction, potential adverse effects and costs of therapy, and patients' personal preferences or values.[7]

Despite the most comprehensive team-based approach and shared decision-making dialogues, socioeconomic factors may limit the effectiveness of recommendations,[8] because they are not encapsulated in the equations used to calculate CVD risk and may create barriers to implementation of prevention strategies.[9]