2019 ACC/AHA Guideline on the Primary Prevention of ...

2019 Guideline on the Primary Prevention of Cardiovascular Disease

GUIDELINES MADE SIMPLE

A Selection of Tables and Figures

Updated September 2019

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?2019, American College of Cardiology B19193

2019 Guideline on the Primary Prevention of Cardiovascular Disease

GUIDELINES MADE SIMPLE

A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Writing Committee:

Donna K. Arnett, PhD, MSPH, FAHA, Co-Chair Roger S. Blumenthal, MD, FACC, FAHA, Co-Chair

Michelle A. Albert, MD, MPH, FAHA Andrew B. Buroker, Esq Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAAN, FAHA, FPCNA Zachary D. Goldberger, MD, MS, FACC, FAHA Ellen J. Hahn, PhD, RN, FAAN Amit Khera, MD, MSc, FACC, FAHA, FASPC Donald Lloyd-Jones, MD, SCM, FACC, FAHA J. William McEvoy, MBBCh, MEd, MHS Erin D. Michos, MD, MHS, FACC, FAHA Michael D. Miedema, MD, MPH Daniel Mu?oz, MD, MPA, FACC Sidney C. Smith, Jr, MD, MACC, FAHA, FESC, FACP Salim S. Virani, MD, PhD, FACC, FAHA Kim A. Williams, Sr, MD, MACC, FAHA, FASNC Joseph Yeboah, MD, MS, FACC, FAHA Boback Ziaeian, MD, PhD, FACC, FAHA

The ACC/AHA Task Force on Clinical Practice Guidelines has commissioned this guideline to consolidate existing recommendations and various recent scientific statements, expert consensus documents, and clinical practice guidelines into a single guidance document focused on the primary prevention of ASCVD. However, this guideline also includes newly generated recommendations for aspirin use, exercise and physical activity, and tobacco use, in addition to recommendations related to team-based care, shared decision-making, and assessment of social determinants of health, to create a comprehensive yet targeted ACC/AHA guideline on the prevention of ASCVD.

The following resource contains tables and figures from the 2019 Guideline on the Primary Prevention of Cardiovascular Disease. The resource is only an excerpt from the Guideline and the full publication should be reviewed for more tables and figures as well as important context.



2019 Guideline on the Primary Prevention of Cardiovascular Disease

GUIDELINES MADE SIMPLE

A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

JACC Central Illustration Tool4 Top Ten Take Home Messages5 Overarching Recommendations for ASCVD Prevention Efforts8 Assessment of Cardiovascular Risk 9 Lifestyle Factors Affecting Cardiovascular Risk10 Type II Diabetes Mellitus11 High Blood Cholesterol12 High Blood Pressure14 Tobacco Use16 Aspirin Use17

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JACC Central Illustration Tool

Primary PrePvreimntairoynP: rLeifveesntytlioenC:hLaifnegsetsylaenCdhTaenagme-sBaansdedTeCaamre-Based Care

Cholesterol

Assess ASCVD Risk, personalize with risk enhancers, reclassify with CAC as needed

High Blood Pressure

Maintain blood pressure below 130/80 mm Hg

Tobacco

Pharmacotherapy + behavior interventions recommended

to maximize quit rates

Prevention of CVD

Physical Activity

Perform 150 mins/week of moderate or 75mins/week of vigorous physical activity

Diet

Emphasis on intake of vegetables, fruits, nuts, legumes, fish

and whole grains

Aspirin Use

Type II Diabetes

Low-dose aspirin for primary prevention

Control through diet and exercise.

now reserved for select high-risk patients

Metformin (primary therapy), SGLT-2 inhibitor or

GLP-1 receptor agonist (secondary)

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Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

(1 of 3)

1The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.

2A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.

3 Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician?patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. In addition, assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.

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Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

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4 All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sugar-sweetened beverages. For adults with overweight/obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.

5 Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.

6 For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.

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Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

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7 All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

8 Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.

9 Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician?patient risk discussion.

10 Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be ................
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