Primary Prevention Guidelines Published for the First Time: Are They Useful for All Patients?

The American College of Cardiology/American Heart Association (ACC/AHA) have recently published primary prevention cardiovascular disease guidelines. They were originally considered very useful for general practitioners who had no choice but to review separately expert consensus or clinical practice guidelines for hypertension, cholesterol, diabetes, etc. Now, everything is concentrated in a single reference document. But is it enough for all patients?

Por primera vez se publican guías de prevención primaria ¿Serán útiles en todos los pacientes?

These guidelines also take into account other risk factors such as diet, exercise, need for aspirin, and tobacco consumption.

The first part focuses on patient-oriented strategies aimed at achieving prevention objectives. The document emphasizes the need for teamwork to handle risk factors.

Then, there is a section on risk assessment, which includes an update of the 2013 definitions that controversially defined low (<5%), intermediate (5 to 7.5%), and high risk (>7.5%) at 10 years. With all the noise caused by the hypertension guidelines, we expected an update that further adjusted such thresholds. However, what we have is the exact opposite. The new thresholds are borderline (5-7.5%), intermediate (7.5 to 19.9%), and high (>20%!!!), always at 10 years.


Read also: Amount of Baseline Ischemia in Patients with Multivessel Disease and Long-Term Progress.


A healthy lifestyle is one of the keys in these guidelines, which emphasize a diet focused on vegetables, fruits, legumes, nuts, whole grains, and fish (basically, a Mediterranean diet). They reduce the consumption of sodium, cholesterol, processed meat, refined carbohydrates, and sugary drinks. Exercise is the other key in lifestyle change, recommending at least 150 minutes of moderate activity or 75 minutes of vigorous-intensity aerobic activities per week.

Finally, these new guidelines focus on weight loss and obesity.

There is a special section on diabetes; class of recommendation I includes lifestyle optimization (nutrition, exercise, and weight loss plan) and the first-line therapy is metformin (class IIa).

For the first time, these guidelines incorporate calcium score as a tool to determine risk when other scores do not seem neither useful nor representative of a patient’s true risk. Starting statin therapy with a calcium score over 100 is a reasonable parameter.


Read also: How to Prevent Pharmacological Overtreating in the Elderly.


The biggest change as regards aspirin in primary prevention is the fact that its category was lowered, from class I to class IIb.

In summary, the 2019 ACC/AHA primary prevention guidelines seem to be an excellent resource to guide the management and treatment of the main risk factors. They can be applied to the wide majority of patients, even though their implementation in real-world clinical practice may be disheartening.

Original Title: Prevention Guidelines: Does one size fit all? Discussion of the 2019 ACC/AHA Primary Prevention of Cardiovascular Disease Guidelines.

Reference: Sophia Larson et al. European Heart Journal, Volume 40, Issue 27, 14 July 2019, Pages 2181–2183.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

AHA 2024 | SUMMIT

It has been previously shown that the pharmacological treatment of obesity (semaglutide) can reduce cardiovascular events in patients with cardiac failure (CF) and preserved...

AHA 2024 – BPROAD

Hypertension (elevated blood pressure, BP) is the most common comorbidity among diabetic patients and has been associated with higher cardiovascular risk, though as a...

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Long Term Results of the International Chimney Registry

The International Chimney Registry was an observational study aimed at assessing the use of chimney stenting during TAVR either to predict or treat coronary...

CANNULATE TAVR extended study: Impact of Commissural and Coronary Alignment in Coronary Cannulation Following TAVR with Evolut Fx

The new valve Evolut FX has shown better commissural alignment vs. its predecessor Evolut Pro+. Prior studies have already shown commissure alignment facilitates post...

TRISCEND II: Transcatheter Replacement vs. Medical Treatment for Tricuspid Regurgitation

The EVOQUE device is designed with an intra-annular sealing system that provides excellent anatomical compatibility and an adaptable shape. It is currently available in...