2019 ACC/AHA Guideline On The Primary Prevention of Cardiovascular Disease: Executive Summary
2019 ACC/AHA Guideline On The Primary Prevention of Cardiovascular Disease: Executive Summary
2019 ACC/AHA Guideline On The Primary Prevention of Cardiovascular Disease: Executive Summary
The full-text guidelines are also available on the following Web sites:
ACC (www.acc.org) and
AHA (professional.heart.org)
2019 Primary Prevention Writing Committee
Donna K. Arnett, PhD, MSPH, FAHA, Co-Chair
Roger S. Blumenthal, MD, FACC, FAHA, Co-Chair
Michelle A. Albert, MD, MPH, FAHA* Erin D. Michos, MD, MHS, FACC, FAHA*
Andrew B. Buroker, Esq† Michael D. Miedema, MD, MPH*
Zachary D. Goldberger, MD, MS, FACC, FAHA‡ Daniel Muñoz, MD, MPA, FACC*
Ellen J. Hahn, PhD, RN* Sidney C. Smith, Jr, MD, MACC, FAHA*
Cheryl D. Himmelfarb, PhD, RN, ANP, FAHA* Salim S. Virani, MD, PhD, FACC, FAHA*
Amit Khera, MD, MSc, FACC, FAHA* Kim A. Williams, Sr, MD, MACC, FAHA*
Donald Lloyd-Jones, MD, SCM, FACC, FAHA* Joseph Yeboah, MD, MS, FACC, FAHA*
J. William McEvoy, MBBCh, MEd, MHS* Boback Ziaeian, MD, PhD, FACC, FAHA§
High blood • Short sleep duration (<6 h) and poor-quality sleep are associated with high blood
pressure pressure and should be considered. Because other lifestyle habits can impact blood
pressure, access to a healthy, low-sodium diet and viable exercise options should
also be considered.
Tobacco • Social support is another potential determinant of tobacco use. Therefore, in adults
treatment who use tobacco, assistance and arrangement for individualized and group social
support counseling are recommended.
Assessment of Cardiovascular Risk
Recommendations for Assessment of Cardiovascular Risk
COR LOE Recommendations
1. For adults 40 to 75 years of age, clinicians should
routinely assess traditional cardiovascular risk factors
I B-NR and calculate 10-year risk of ASCVD by using the pooled
cohort equations (PCE).
2. For adults 20 to 39 years of age, it is reasonable to
IIa B-NR assess traditional ASCVD risk factors at least every 4 to 6
years.
3. In adults at borderline risk (5% to <7.5% 10-year ASCVD
risk) or intermediate risk (≥7.5% to <20% 10-year ASCVD
IIa B-NR risk), it is reasonable to use additional risk-enhancing
factors to guide decisions about preventive
interventions (e.g., statin therapy).
Assessment of Cardiovascular Risk (cont’d)
Recommendations for Assessment of Cardiovascular Risk
COR LOE Recommendations
4. 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
IIa B-NR preventive interventions (e.g., statin therapy) remain
uncertain, it is reasonable to measure a coronary artery
calcium score to guide clinician–patient risk discussion.
CAC Measurement Candidates Who Might Benefit from Knowing Their CAC
Score Is Zero
• Patients reluctant to initiate statin who wish to understand their risk and
potential for benefit more precisely
• Patients concerned about need to reinstitute statin therapy after
discontinuation for statin-associated symptoms
• Older patients (men 55–80 y of age; women 60–80 y of age) with low
burden of risk factors (S4.4-42) who question whether they would benefit
from statin therapy
• Middle-aged adults (40–55 y of age) with PCE-calculated 10-year risk for
ASCVD 5% to <7.5% with factors that increase their ASCVD risk, although
they are in a borderline risk group.
Adults with High Blood Pressure or Hypertension
Recommendations for Adults with High Blood Pressure or Hypertension