Fast Five Quiz: Coronary Artery Atherosclerosis

Yasmine S. Ali, MD


November 11, 2019

According to guidelines from the ACC/AHA, for patients younger than 19 years with familial hypercholesterolemia, a statin is indicated. For young adults (aged 20-39 years), priority should be given to estimating lifetime risk and promoting a healthy lifestyle. Statins should be considered in those with a family history of premature atherosclerotic CVD and low-density lipoprotein C levels ≥ 160 mg/dL.

For patients aged 20-39 years, the ACC/AHA guidelines recommend measuring traditional risk factors every 4-6 years to identify major factors (eg, tobacco, dyslipidemia, family history of premature heart disease, chronic inflammatory diseases, hypertension, or type 2 diabetes mellitus) that provide rationale for optimizing lifestyle and tracking risk factor progression and need for treatment.

The ACC/AHA guidelines state that CAC measurement is not intended as a "screening" test for all, but should be used to help guide decision-making in selected adults to facilitate the clinician-patient risk discussion. The absence of CAC does not rule out noncalcified plaque, and clinical judgment about risk should prevail.

Although low-dose aspirin was widely administered for atherosclerotic CVD prevention, the ACC/AHA guidelines now suggest that aspirin should not be used in routine primary prevention owing to lack of net benefit. The following are recommendations:

  • Low-dose aspirin may be considered for primary prevention of atherosclerotic CVD in selected higher adults aged 40-70 years who are not at increased risk for bleeding.

  • Low-dose aspirin should not be administered on a routine basis for primary prevention among adults > 70 years.

  • Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased risk for bleeding.

Read more about preventive strategies.


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