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Guideline Summary

This guideline synthesizes prior guidelines and recent studies relevant to atherosclerotic cardiovascular disease (ASCVD), focusing on primary prevention of ASCVD events (acute coronary syndrome, myocardial infarction, stable or unstable angina, arterial revascularization, stroke/transient ischemic attack, peripheral arterial disease) as well as heart failure and atrial fibrillation in adults. Key recommendations are related to lifestyle factors, conditions affecting ASCVD risk, and care models (see accompanying Hurst's Central Illustration).

Commentary

Guideline Strengths: This guideline was designed to address many different aspects of primary prevention of ASCVD among adults. As such, many recommendations were adapted from existing condition-specific guidelines, but recommendations were also supported with independent literature reviews. Guideline recommendations incorporated recent high-impact randomized controlled trials in several different topic areas, including aspirin use and diabetes pharmacotherapy. Recommendations were given standard Class of Recommendation and Level of Evidence designations.

Guideline Limitations: The importance of implementing lifelong healthy habits early in life cannot be overstated. Subclinical atherosclerotic disease begins to develop at a young age, yet ASCVD risk-estimation assessment and subsequent interventions may only start at age 40 years. Future study and emphasis on early-life modification of health habits will be important for the true primary prevention of cardiovascular disease.

Next Steps/Clinical Perspective: Intentionally, this guideline provides a comprehensive overview of primary prevention of ASCVD and draws from recent, more-detailed guideline recommendations in several topics. Recommendations will need to be updated as new data are collected, including with regard to individuals younger than 40 years of age.

Guideline Reference

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Arnett  DK, Blumenthal  RS, Albert  MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease. J Am Coll Cardiol. doi: 10.1016/j.jacc.2019.03.010

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