‘ABCs’ of primary and secondary CVD prevention have expanded over the years
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The “ABCs” have provided a roadmap for primary and secondary CVD prevention since 1999, according to a speaker at the virtual American Society for Preventive Cardiology Congress on CVD Prevention.
Since then, the ABC’s have expanded and were adapted based on changing guidelines and newer evidence-based approaches to care. Cardiology Today Prevention Section Editor Roger S. Blumenthal, MD, FACC, FAHA, Kenneth Jay Pollin Professor of Cardiology and director of the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins School of Medicine, discussed these changes and more during his presentation.
Blumenthal said the ABC structure originated in the 1999 American Heart Association/American College of Cardiology guidelines for management of stable angina, chaired by Raymond J. Gibbons, MD.
“We modified the ABC approach over the years” to an ABCDE approach, Blumenthal said. "For this talk, we've added an ‘F’ for failure or heart failure, as seen in the 2019 primary prevention guidelines,” Blumenthal said.
He said in its present form, an outline of the 'ABCDEF' of CVD prevention would read as such:
A (Assessment and Aspirin) Adults aged 40 to 75 years should be routinely assessed for traditional CVD risk factors and clinicians calculate 10-year risk for ASCVD using the pooled cohort equations. According to the presentation, low-dose aspirin (75 to 100 mg per day) can be considered among adults who are current or recent smokers, have a family history of atherosclerotic CVD, hypercholesterolemia with statin intolerance, subclinical atherosclerosis (coronary artery calcium score > 100) or among patients with a 10-year ASCVD risk at least 20%.
B (Blood Pressure) Among adults with elevated BP, including those requiring medical therapy, recommended interventions include weight loss (if overweight), healthy diet, sodium reduction, dietary potassium supplementation, increased physical activity and limited alcohol consumption.
C (Cholesterol and Cigarette Cessation) Statin therapy is the first-line approach for primary prevention among patients with elevated LDL, those with diabetes or those at sufficient ASCVD risk. Additionally, nicotine replacement or other pharmacotherapies are recommended to aid in smoking cessation. All adults and adolescents should avoid secondhand smoke exposure.
D (Diabetes/Glucose Management and Diet/Weight) Clinicians should urge patients to improve consumption of vegetables, fruits, legumes, nuts, whole grains and fish to decrease risk factors; replacement of saturated fat with monounsaturated and polyunsaturated fats; reduce dietary cholesterol and sodium; and minimize intake of processed meats, refined carbohydrates and sweetened beverages.
E (Exercise/Education) – Sedentary behavior should be avoided, and people should participate in 300 minutes of moderate-intensity or 150 minutes of vigorous-intensity physical activity per week.
F (Heart Failure) Sequential implementation of evidence-based HF therapies, including ACE inhibitors/angiotensin receptor blockers, beta-blockers, aldosterone antagonists, angiotensin receptor-neprilysin inhibitors and SGLT2 inhibitors can lower both relative mortality risk and 2-year mortality rates in patients with HF.
“If you take our guidelines and put them in an ABC approach, we start off with assessment of cardiovascular risk and that means the emphasis is on shared decision-making but also a team-based approach using nurses, nurse health educators, nurse practitioners and pharmacists,” Blumenthal said. “We also must keep in mind that the final decision is up to the patient about how aggressive we are with medication management, or how long we focus on lifestyle by itself. Clearly the health care professional needs to present the data in a way that patients can understand.”
References:
- Arnett DK, et al. Circulation. 2019;doi:10.1161/CIR.0000000000000678.
- Ferraro R, et al. J Am Coll Cardiol. 2020;doi:10.1016/j.jacc.2020.08.078.
- Gibbons RJ, et al. Circulation. 1999;doi:10.1161/01.cir.99.21.2829.
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Blumenthal R. Opening Session. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 23-25, 2021 (virtual meeting).
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