primary prevention of cardiovascular disease
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Management
- counselling may be of some benefit to some patients (grade C recommendation) USPSTF[11][12]
- minimize cardiac risk factors
- control blood pressure, chronic hypertension
- role of statins & antiplatelet agents controversial
- USPSTF recommended aspirin prophylaxis (primary prevention) for:[1][2][3][18]
- USPSTF reccommends low-dose aspirin for primary prevention of cardiovascular disease in adults 50-59 years of age with a 10-year cardiovascular risk of >= 10%[18]
- reduces myocardial infarction & ischemic stroke[20]
- risk for nontrivial bleeding roughly equals benefit in primary prevention of nonfatal myocardial infarction[4]
- no benefit in primary prevention of fatal myocardial infarction[4]
- FDA & AHA/ACC recommend against aspirin for primary prevention[5][14]
- statins for primary prevention
- statins are recommended with lifestyle changes for patients with elevated LDL cholesteroal (>= 190 mg/dL), type 2 diabetes, or other cardiovascular risk factors[14]
- benefit of statins for primary prevention confirmed[6]
- benefits in patients with low cardiovascular risk (5 year risk < 10%) similar to benefits in high-risk patients[6]
- suggestion is made that everyone over 50 years of age should take a statin: allegedly, benefits of statins outweigh risks, even in the healthiest patients[6]
- reduction in myocardial infarction & ischemic stroke[20]
- no reduction in mortality[6]
- no mortality benefit for primary prevention[7]
- benefit for primary prevention in the elderly (73 +/- 3 years)[8]; does not reduce all-cause mortality[8]
- in older adults with at least one risk factor*, rosuvastatin 10 mg/day lowers mean LDL cholesterol level by 35 mg/dL, & reduces combined outcomes of CV-related death, nonfatal ischemic stroke, or nonfatal myocardial infarction vs placebo (3.7 vs 4.8%)[10]
- rosuvastatin & other statins do not lower all-cause mortality[10][20]
- financial incentives associated with statin recommendations for primary prevention rarely (if ever) discussed
- statins never compared directly with Mediterranean diet
- PCSK9 inhibitors reduce myocardial infarction & ischemic stroke[20]
- ezetimibe reduces myocardial infarction & ischemic stroke[20]
- candesartan/HCTZ (16/12.5 mg) reduced combined outcome vs placebo only in a subgroup with baseline systolic BP > 143 mm Hg (4.8 vs 6.5%)
- soluble (viscous) fiber lowers LDL cholesterol & estimated 10-year cardiovascular risk[15][16][17]
- meditation may reduce cardiovascular mortality[13]
- no benefit for vitamins & antioxidants[9]
* elevated waist-hip ratio, low HDL cholesterol, current smoking, or diet-controlled diabetes
Notes
Additional terms
- cardiovascular disease (CVD)
- cardiovascular risk calculator; cardiovascular risk score
- cardiovascular risk factor
- coronary artery disease; coronary atherosclerosis (CAD)
- ischemic stroke
- peripheral vascular disease (PVD)
- secondary prevention in patients with cardiovascular disease
References
- ↑ 1.0 1.1 U.S. Preventive Services Task Force Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. 2009 Mar 17;150(6):396-404. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19293072
Wolff T, Miller T, Ko S. Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2009 Mar 17;150(6):405-10. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19293073 - ↑ 2.0 2.1 U.S. Preventive Services Task Force recommendation statement. Aspirin for the Prevention of Cardiovascular Disease http://www.ahrq.gov/clinic/USpstf/uspsasmi.htm
- ↑ 3.0 3.1 Prescriber's Letter 17(2): 2010 Aspirin for Primary Prevention Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260201&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 Seshasai SRK et al. Effect of aspirin on vascular and nonvascular outcomes: Meta-analysis of randomized controlled trials. Arch Intern Med 2012 Feb 13; 172:209 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22231610
Mora S. Aspirin therapy in primary prevention: To use or not to use? Arch Intern Med 2012 Feb 13; 172:217. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22231608 - ↑ 5.0 5.1 Husten L FDA Comes Out Against Aspirin for Primary Prevention Physician's First Watch, May 6, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
FDA.Information for Consumers. May 2, 2014. Use of Aspirin for Primary Prevention of Heart Attack and Stroke. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm390574.htm - ↑ 6.0 6.1 6.2 6.3 6.4 Cholesterol Treatment Trialists' (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials. Lancet 2012 May 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22607822 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60367-5/fulltext
Ebrahim S and Casas JP. Statins for all by the age of 50 years? Lancet 2012 May 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22607823 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60694-1/fulltext - ↑ 7.0 7.1 Prescriber's Letter 17(8): 2010 Statins for Primary Prevention Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260802&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 8.0 8.1 8.2 Savarese G et al Benefits Of Statins In Elderly Subjects Without Established Cardiovascular Disease. A Meta-Analysis. J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23954343 <Internet> http://content.onlinejacc.org/article.aspx?articleid=1732396
Waters DD Meta-analyses of Statin Trials: Clear Benefit for Primary Prevention in the Elderly. J Am Coll Cardiol. 2013 Dec 3;62(22):2100-1 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23994398 <Internet> http://content.onlinejacc.org/article.aspx?articleid=1732395 - ↑ 9.0 9.1 The NNT: Vitamin and Antioxidant Supplements for Primary Prevention of Cardiovascular Disease. http://www.thennt.com/nnt/vitamins-and-antioxidants-for-primary-prevention-of-cardiovascular-disease/
- ↑ 10.0 10.1 10.2 Lonn EM et al Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med. April 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27041480 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1600175
Yusuf S et al Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med. April 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27040132 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1600176
Yusuf S et al Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease. N Engl J Med. April 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27039945 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1600177
Cushman WC, Goff DC, Jr. More HOPE for Prevention with Statins N Engl J Med. April 2, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27039666 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1603504 - ↑ 11.0 11.1 Capewell S, Dowrick C. Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors. Is Behavioral Counselling Necessary? JAMA Intern Med. Published online July 11, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697229 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2643083
- ↑ 12.0 12.1 US Preventive Services Task Force Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors. US Preventive Services Task Force Recommendation Statement. JAMA. 2017;318(2):167-174 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697260 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643315
Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;318(2):175-193 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697259 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643314
Greenland P, Fuster V. Cardiovascular Risk Factor Control for All. JAMA. 2017 Jul 11;318(2):130-131. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28697239 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2643292 - ↑ 13.0 13.1 Levine GN, Lange RA, Bairey-Merz CN et al Meditation and Cardiovascular Risk Reduction A Scientific Statement From the American Heart Association. J Am Heart Assoc. Sept 28, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28963100 Free full text <Internet> http://jaha.ahajournals.org/content/6/10/e002218
- ↑ 14.0 14.1 14.2 WRITING COMMITTEE MEMBERS, Arnett DK et al 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. J Am Coll Cardiol. March 2019 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30894319 <Internet> http://www.onlinejacc.org/content/early/2019/03/07/j.jacc.2019.03.010
Bittner VA The New 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Circulation. March 17, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30879338 https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.119.040625 - ↑ 15.0 15.1 Salvado J, Jenkins DJA, Kendall CWC, Sievenpiper JL. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018 May-Jun;61(1):43-53 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29807048 Review
- ↑ 16.0 16.1 Surampudi P, Enkhmaa B, Anuurad E, Berglund L. Lipid Lowering with Soluble Dietary Fiber. Curr Atheroscler Rep. 2016 Dec;18(12):75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27807734 Review.
- ↑ 17.0 17.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 18.0 18.1 18.2 18.3 US Preventive Services Task Force Aspirin Use to Prevent Cardiovascular Disease. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577-1584. April 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35471505
Guirguis-Blake JM et al. Aspirin use to prevent cardiovascular disease and colorectal cancer: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2022 Apr 26; 327:1585-1597 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35471507 https://jamanetwork.com/journals/jama/fullarticle/2791401
Brett AS Should Patients Take Aspirin for Primary Cardiovascular Prevention? Updated Recommendations From the US Preventive Services Task Force. JAMA. 2022;327(16):1552-1554 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35471530 https://jamanetwork.com/journals/jama/fullarticle/2791432 - ↑ 19.0 19.1 Khan SS, Matsushita K, Sang Y et al. Development and Validation of the American Heart Association's PREVENT Equations. Circulation. 2024 Feb 6;149(6):430-449. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37947085 PMCID: PMC10910659 (available on 2025-02-06)
- ↑ 20.0 20.1 20.2 20.3 20.4 20.5 Di Palo, Feder S, Baggenstos YT et al Palliative Pharmacotherapy for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2024 Jul 1:e000131 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38946532 Free article. Review. https://www.ahajournals.org/doi/epdf/10.1161/HCQ.0000000000000131