For adults aged 40-75 years, routinely assess traditional CV risk factors and calculate their 10-year ASCVD risk with the pooled cohort equations (PCE). For those aged 20-39 years, it is reasonable to assess traditional ASCVD risk factors at least every 4-6 years.
In adults at borderline risk (5% to <7.5% 10-year ASCVD risk) or intermediate risk (≥7.5% to <20% 10-year ASCVD risk), using additional risk-enhancing factors is reasonable to guide decisions about preventive interventions (eg, statin therapy).
In adults at intermediate risk (≥7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10-year ASCVD risk), if risk-based decisions for preventive interventions (eg, statin therapy) remain uncertain, measuring a CAC score to guide the clinician-patient risk discussion is reasonable, as follows:
CAC = 0: Withholding statin therapy is reasonable; reassess in 5-10 years if higher risk conditions are absent (eg, diabetes, family history of premature coronary heart disease, tobacco use).
CAC = 1-99: Initiating statin therapy is reasonable for those aged 55 years or older.
CAC is ≥100, or is in ≥75th percentile: Initiating statin therapy is reasonable.
For adults aged 20-39 years and for those aged 40-59 years whose 10-year ASCVD risk is below 7.5%, consider estimating their lifetime or 30-year ASCVD risk.
In adults at intermediate risk (≥7.5% to <20% 10-year ASCVD risk):
If statin therapy is decided upon, use a moderate-intensity agent.
Reduce LDL-C levels by ≥30%; for optimal ASCVD risk reduction, particularly in high-risk patients (≥20% 10-year ASCVD risk), reduce LDL-C levels by ≥50%.
In the setting of risk-enhancing factors, initiating or intensifying statin therapy is favored.
In diabetic adults aged 40-75 years, regardless of the estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated. High-intensity statin therapy is reasonable for diabetic adults with multiple ASCVD risk factors to reduce LDL-C levels by 50% or more.
The maximally tolerated statin therapy is recommended in patients aged 20-75 years with LDL-C levels of 190 mg/dL (≥4.9 mmol/L) or higher.
Blood pressure (BP)-lowering agents are recommended for the following patients:
Adults with an estimated 10-year ASCVD risk of ≥10% and an average BP of ≥130/80 mmHg (for primary CVD prevention)
Adults with an estimated 10-year ASCVD risk <10% and a BP of ≥140/90 mmHg
Low-dose aspirin (75-100 mg orally daily) guidance includes the following:
Consider for primary ASCVD prevention in select adults aged 40-70 years who have higher ASCVD risk but not an increased bleeding risk.
Do not routinely administer for primary ASCVD prevention in adults >70 years as well as in adults of any age who have a higher bleeding risk.
For more information, please go to Primary and Secondary Prevention of Coronary Artery Disease.
For more Clinical Practice Guidelines, please go to Guidelines.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Cardiovascular Disease Primary Prevention Clinical Practice Guidelines (ACC/AHA 2019) - Medscape - Mar 26, 2019.