Cardiovascular Disease Prevention and Management Clinical Practice Guidelines (2018)

Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE)

Reviewed and summarized by Medscape editors

November 01, 2018

Risk Stratification

Complete a CV risk assessment every 5 years for men and women aged 40-75 years, or whenever there is a change in a patient's expected risk status, using the modified Framingham Risk Score (FRS) or Cardiovascular Life Expectancy Model (CLEM) to guide therapeutic interventions for lowering major CV events.

Calculate and discuss a patient's “CV age” to improve their likelihood of achieving lipid targets and that poorly controlled hypertension will be treated. Share the results of the risk assessment with the patient for joint decision-making and improving their likelihood of achieving lipid targets.

Treatment Targets


All diabetic individuals should follow a comprehensive, multifaceted approach for CV risk reduction, including the following:

  • An A1C of ≤7% implemented early in the course of diabetes (type 1 or 2)

  • SBP <130 mmHg and DBP <80 mmHg

  • Additional vascular-protective medications in most diabetic adults

  • Achievement and maintenance of healthy weight goals

  • Healthy eating, regular physical activity, and smoking cessation


A target level of LDL-C consistently <2.0 mmol/L or a >50% LDL-C reduction in those who have initiated treatment is recommended for risk reduction of CVD events. Alternatively, target variables include an apolipoprotein B (apoB) level <0.8 g/L or non-HDL-C level <2.6 mmol/L.

For those with an LDL-C level >5.0 mmol/L who have initiated therapy, a >50% reduction is recommended for reduction of CVD events and death.


For nonhypertensive persons (to lower the risk of hypertension) or hypertensive patients (to lower BP), clinicians should prescribe the accumulation of 30-60 min of moderate intensity dynamic exercise 4-7 days each week in addition to the routine activities of daily living.

For high-risk patients aged 50 years or older with SBP levels of ≥130 mmHg, target an SBP level of ≤120 mmHg. Use AOBP measurements to guide intensive therapy; patient selection is recommended for intensive management, and caution is advised in certain high-risk groups.

Prescribe antihypertensive therapy for average DBP measurements of ≥100 mmHg, or average SBP measurements of ≥160 mmHg in those without macrovascular target organ damage or other CV risk factors. Strongly consider antihypertensive therapy for average DBP measurements of ≥90 mmHg, or for average SBP measurements of ≥140 mmHg in the presence of macrovascular target organ damage or other independent CV risk factors.


Previously sedentary individuals initiating activity should begin with light activity and gradual increases. Encourage all obese individuals considering beginning a vigorous exercise program to consult their physician or healthcare team professionals.


After the acute phase of a stroke, use BP-lowering therapy to target a consistent BP <140/90 mmHg.


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