2019 ACC/AHA Guideline: Primary Prevention CVD:

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Part 1, Lifestyle and Behavioral Factors

Donna K. Arnett, PhD, MSPH¹; Amit Khera, MD, MSc²; Roger S. Blumenthal, MD³

Author Affiliations Article Information

JAMA Cardiol. Published online July 31, 2019. doi:10.1001/jamacardio.2019.2604

Guideline title: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Developers: American College of Cardiology and American Heart Association

Release date: March 17, 2019 (online)

Funding sources: American College of Cardiology and American Heart Association

Target population: Adults 18 years and older who are free of atherosclerotic cardiovascular disease

Major recommendations:

• Team-based care is an effective approach for the primary prevention of atherosclerotic cardiovascular disease.
• Social determinants of health should be incorporated into shared decision-making to optimize preventive care.
• Individuals should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, and fish.
• Individuals should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.
• Health care professionals should identify individuals with overweight or obesity and provide counseling and comprehensive lifestyle interventions, including caloric restriction, to achieve and maintain weight loss.
• All adults should be assessed at every health care visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

Summary of the Clinical Problem

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Most individuals who develop ASCVD have at least 1 antecedent major risk factor, and very few have optimal levels of all risk factors and behavioral factors. Lifestyle and behavioral factors are the foundation of ASCVD prevention, and maintaining healthy habits can help preserve good cardiovascular health over the life course. The key to effective prevention is a comprehensive approach, emphasizing a healthy lifestyle and addressing all major risk factors. The 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease incorporates existing guidelines, statements, and consensus documents into a single comprehensive resource for patients, health care professionals, and public health officials.¹ Recommendations to prevent ASCVD (coronary heart disease, stroke, and peripheral artery disease), atrial fibrillation, and heart failure in adults include lifestyle factors (eg, nutrition, exercise or physical activity, overweight and obesity, and tobacco use) and treatment-associated factors (eg, risk assessment, blood pressure level, blood cholesterol level, diabetes, and aspirin use). This article focuses on lifestyle factors.