Cardiovascular Disease Primary Prevention Clinical Practice Guidelines (ACC/AHA 2019)

American College of Cardiology and American Heart Association

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 26, 2019

Select Recommendations

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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