Family medicine

The American College of Cardiology (ACC) and the American Heart Association (AHA) have released new guidance on the primary prevention of cardiovascular disease. As expected, one of the major changes is a recommendation against the broad use of aspirin in primary prevention, after recently reported results of the ARRIVE, ASCEND, and ASPREE trials called the balance of risk and benefit with treatment into question in a variety of populations.

Writing committee

The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease is publish online March 17 in the Journal of the American College of Cardiology and Circulation and present here at the American College of Cardiology 68th Annual Scientific Session 2019.

The document is also endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Geriatrics Society; Therefore the American Society of Preventive Cardiology; and the Preventive Cardiovascular Nurses Association. Co-chairs of the writing committee are Donna K.

Arnett, PhD, dean and professor of epidemiology at the University of Kentucky College for Public Health; and past president of the American Heart Association; and Roger Blumenthal, MD, professor of medicine at the Johns Hopkins School of Medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.

The new guideline

During a press conference here; presidents of the both the ACC and AHA discussed the goals of the new guideline. “What we’re here to talk about today is the fact is that through lifestyle choices and modifications; nearly 80% of all cardiovascular disease can be prevented;” John J. Warner, MD, immediate past president of the American Heart Association and executive vice president for Health System Affairs; UT Southwestern Medical Center; Dallas.

“These 2019 prevention guidelines look at the whole person and how individuals; working hand in hand with their clinicians and physicians; can manage their vulnerabilities.” The document emphasizes healthy lifestyle as “the most important part of prevention throughout the entire lifespan; but these guidelines also look at prevention from a new lens of social determinants of health;” Warner noted.

Determinants of health

“Based on scientific evidence, They now know that only 10% to 20% of our health is actually determine by the healthcare that we receive, and 70% to 80% is impacted by social determinants of health. Undeserved and low-income populations have a higher risk of heart disease and life expectancy can vary by more than 20 years in people living only 5 miles apart.”
Richard Kovacs, MD, professor of clinical medicine and clinical director of the Krannert Institute of Cardiology; Indiana University School of Medicine; Indianapolis, is vice president of the American College of Cardiology and takes on the role of ACC president during this meeting. Because He congratulated the writing committee for completing this task in 1 year; through 33 peer reviews.
“This is going to be a comprehensive resource for both clinical and public health practices in terms of the prevention of cardiovascular disease; Therefore  and it dovetails quite nicely with other guidelines;” Kovacs said, updating the 2013 CV Risk and 2013 Lifestyle guidelines, and the 2013 overweight and obesity guidelines; but also “includes and replicates” portions of the 2017 blood pressure guidelines and the 2018 cholesterol guideline.