American College of Cardiology and American Heart Association: guideline on the primary prevention of cardiovascular disease

2020 ◽  
Vol 15 (6) ◽  
pp. 1-6
Author(s):  
Belinda Linden
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
American Heart Association Guideline ◽  
Cardiovascular Nursing ◽  
Prevention Of Cardiovascular Disease

Belinda Linden presents a quarterly overview of recently published guidance of relevance to cardiovascular nursing. A guideline on reducing cardiovascular risk through primary prevention in adults is reviewed in this update.

Cardiovascular disease prevention guidelines

ESC CardioMed ◽  
2018 ◽  
pp. 2834-2836
Author(s):  
Janet Wei
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
American Heart Association ◽  
Cardiovascular Prevention ◽  
Heart Association ◽  
Prevention Guidelines ◽  
European Society Of Cardiology ◽  
Cholesterol Management ◽  
Prevention Of Cardiovascular Disease

Cardiovascular prevention guidelines recommend systemic cardiovascular risk assessment in women, recognizing that women have a high lifetime risk of cardiovascular disease. While there are differences in the approach to risk assessment, both the American Heart Association and the European Society of Cardiology recommend estimation of a 10-year risk of cardiovascular disease. This chapter discusses the guidelines for aspirin use, cholesterol management, and lifestyle factors for prevention of cardiovascular disease.

scholarly journals Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019

Circulation ◽  
2020 ◽  
Vol 141 (19) ◽  
pp. 1541-1553 ◽  
Author(s):  
Miguel Cainzos-Achirica ◽  
Michael D. Miedema ◽  
John W. McEvoy ◽  
Mahmoud Al Rifai ◽  
Philip Greenland ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Relative Risk ◽  
Primary Prevention ◽  
American Heart Association ◽  
Relative Risk Reduction ◽  
American Heart ◽  
Heart Association ◽  
Risk Of Bleeding ◽  
Ascvd Risk

Background: Recent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. Methods: The study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: <5%, 5% to 20%, and >20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT 5 ) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH 5 ) estimations. Results: Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants <70 years of age not at high risk of bleeding (n=3540). The overall NNT 5 with aspirin to prevent 1 cardiovascular disease event was 476 and the NNH 5 was 355. The NNT 5 was also greater than or similar to the NNH 5 among estimated ASCVD risk strata. Conversely, CAC≥100 and CAC≥400 identified subgroups in which NNT 5 was lower than NNH 5 . This was true both overall (for CAC≥100, NNT 5 =140 versus NNH 5 =518) and within ASCVD risk strata. Also, CAC=0 identified subgroups in which the NNT 5 was much higher than the NNH 5 (overall, NNT 5 =1190 versus NNH 5 =567). Conclusions: CAC may be superior to the pooled cohort equations to inform the allocation of aspirin in primary prevention. Implementation of current 2019 American College of Cardiology/American Heart Association guideline recommendations together with the use of CAC for further risk assessment may result in a more personalized, safer allocation of aspirin in primary prevention. Confirmation of these findings in experimental settings is needed.

scholarly journals The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk

Circulation ◽  
2020 ◽  
Vol 141 (7) ◽  
pp. 592-599 ◽  
Author(s):  
Anandita Agarwala ◽  
Erin D. Michos ◽  
Zainab Samad ◽  
Christie M. Ballantyne ◽  
Salim S. Virani
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

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