The American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines on the assessment of cardiovascular risk, lifestyle management to reduce cardiovascular risk, treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults, and the management of overweight and obesity in adults.
These four guideline documents, sponsored by the National Heart, Lung, and Blood Institute (NHLBI), include two first-time recommendations and a big shift from the current management of adults at risk for cardiovascular disease.
The cholesterol guidelines update the last Adult Treatment Panel III (ATP3) guidelines from 2001, with an update in 2004. The last overweight and obesity guidelines were from 1998.
Below are some of the key recommendations for each of the guidelines:
Guideline on the Assessment of Cardiovascular Risk
- The race- and sex-specific Pooled Cohort Equations to predict 10-year risk for a first hard atherosclerotic cardiovascular disease (ASCVD) event should be used in non-Hispanic African-Americans and non-Hispanic Whites, 40–79 years of age
- Use of the sex-specific Pooled Cohort Equations for non-Hispanic Whites may be considered when estimating risk in patients other than African Americans and non-Hispanic Whites
- If, after quantitative risk assessment, a risk-based treatment decision is uncertain, assessment of >1 of the following— family history, hs-CRP, CAC score, or ABI—may be considered to inform treatment decision making
- It is reasonable to assess traditional ASCVD risk factors every 4–6 years in adults 20–79 years of age who are free from ASCVD, and to estimate 10-year ASCVD risk every 4–6 years in adults 40–79 years of age without ASCVD
Guideline on Lifestyle Management to Reduce Cardiovascular Risk
- Emphasis on intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages and red meats
- Aim for a dietary pattern that achieves 5% to 6% of calories from saturated fat.
- Reduce percent of calories from saturated and trans fat.
- Combine the DASH dietary pattern with lower sodium intake
Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
- High-intensity statin therapy should be initiated or continued as first-line therapy in women and men ≤75 years of age who have clinical ASCVD, unless contraindicated
- In individuals with clinical ASCVD in whom high-intensity statin therapy would otherwise be used, when high-intensity statin therapy is contraindicated or when characteristics predisposing to statin-associated adverse effects are present, moderate-intensity statin should be used as the second option if tolerated
- Individuals with LDL–C ≥190mg/dL or TG ≥500mg/dL should be evaluated for secondary causes of hyperlipidemia
- Adults ≥21 years of age with primary LDL–C ≥190mg/dL should be treated with statin therapy (10-year ASCVD risk estimation not required): Use high-intensity statin therapy unless contraindicated; for individuals unable to tolerate high-intensity statin therapy, use the max tolerated statin intensity
- Moderate-intensity statin therapy should be initiated or continued for adults 40–75 years of age with diabetes mellitus
- The Pooled Cohort Equations should be used to estimate 10-year ASCVD risk for individuals with LDL–C 70–189mg/dL without clinical ASCVD to guide initiation of statin therapy for the primary prevention of ASCVD
- Adults 40–75 years of age with LDL–C 70–189mg/dL, without clinical ASCVD or diabetes and an estimated 10-year ASCVD risk ≥7.5% should be treated with moderate- to high-intensity statin therapy
Guideline for the Management of Overweight and Obesity in Adults
- Use the current cutpoints for overweight (BMI >25.0–29.9kg/m2) and obesity (BMI ≥30kg/m2) to identify adults who may be at elevated risk of CVD and the cutpoints for obesity (BMI ≥30) to identify adults who may be at elevated risk of mortality from all causes
- Counsel overweight and obese adults with CV risk factors (eg, high BP, hyperlipidemia, hyperglycemia), that lifestyle changes that produce even modest, sustained weight loss of 3%-5% produce clinically meaningful health benefits
- Prescribe a calorie-restricted diet, for obese and overweight individuals who would benefit from weight loss, based on the patient’s preferences and health status and preferably refer to a nutrition professional for counseling
- Advise overweight and obese individuals who would benefit from weight loss to participate for ≥6 months in a comprehensive lifestyle program that assists in adhering to a lower calorie diet and in increasing physical activity
- Prescribe on site, high-intensity (eg, ≥14 sessions in 6 months) comprehensive weight loss interventions provided in individual or group sessions by a trained interventionist
- For weight loss maintenance, prescribe face-to-face or telephone-delivered weight loss maintenance programs that provide regular contact (monthly or more frequent) with a trained interventionist who helps participants engage in high levels of physical activity, monitor body weight regularly, and consume a reduced-calorie diet
For more information call (800) 242-8721 or read the Circulation issue online.