What You Need to Know About the New Prevention Guidelines

photo of Penny Kris-EthertonPenny M. Kris-Etherton, Distinguished Professor of Nutrition, The Pennsylvania State University, Ph.D., R.D.N., L.D.N., FAHA, FNLA, FASN, CLS

We’ve said it before, and now we have even more evidence to back it up: The most important way to prevent cardiovascular disease is through a healthy lifestyle throughout life. That’s a key message of new guidelines on the Primary Prevention of Cardiovascular Disease, released today by the American Heart Association and the American College of Cardiology. The guidelines are an update to the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk.

Most CVD events can be avoided by preventing and/or controlling risk factors, such as high blood pressure and high cholesterol, and by following a heart-healthy lifestyle that includes getting adequate physical activity, following a healthy dietary pattern and avoiding tobacco (including secondhand smoke). Yet millions of Americans are living with these risk factors, many do not have their risk factors under control, and our nation’s predominant lifestyle habits do not exactly promote ideal heart health.

The new recommendations – based on the latest science – cover the topics of managing cholesterol, high blood pressure, obesity and diabetes; tobacco cessation; and following a healthy lifestyle. They incorporate recommendations from and consistent with recently released blood pressure, cholesterol and physical activity guidelines.

Here are the highlights:

  1. Adults should eat a heart-healthy dietary pattern by:
    • Emphasizing plant-based foods such as vegetables, fruits, legumes, nuts, whole grains, lean protein and fish;
    • Limiting foods high in saturated fats and dietary cholesterol (for example, meat and organ meats, full-fat dairy products, eggs and tropical oils such as coconut and palm oil);
    • Minimizing trans fat, sodium (salt), processed meats, refined carbohydrates and sweetened beverages.
  2. Adults should be physically active most days of the week, getting in 150 minutes per week of moderate- intensity exercise – such as brisk walking – or 75 minutes a week of vigorous physical activity, such as jogging.
  3. Adults should avoid tobacco smoke, including secondhand smoke. Health care providers should discuss this at each visit. The guidelines advise providers to help patients build a plan to quit smoking or reduce exposure to secondhand smoke.
  4. Health care providers should not prescribe aspirin therapy for primary prevention because of the risk of bleeding, except in carefully selected patients.
  5. Adults diagnosed as overweight or obese should be encouraged to seek comprehensive counseling and advised to restrict calories and become more physically active.
  6. Adults who have Type 2 diabetes, as well as adults with high blood pressure, should be strongly encouraged and counseled by health care providers about lifestyle changes as a key part of their treatment plan. Treatment plans may also include medication.
  7. Health care providers should consider treating adults with a significant risk of cardiovascular disease with statin therapy to reduce risk. Everyone can check their individual risk scores with the Check. Change. Control. Calculator. Risk-enhancing factors also may help guide clinical decision-making.
  8. People older than 40 should be evaluated for risk of cardiovascular disease using the AHA/ACC ASCVD Risk Calculator every 10 years. (This is the calculator used by health care professionals.)
  9. Health care providers should consider the “whole person” by:
    • Focusing on shared decision-making – understanding patients’ concerns and helping them make informed decisions;
    • Using team-based care, for example, referring patients to specialists such as registered dietitians, psychologists and physical therapists when practical;
    • Understanding social determinants of health, such as a patient’s willingness and ability to make lifestyle changes, health literacy, socioeconomic status, neighborhood settings, social support, socioeconomic factors and others.

The AHA has developed a suite of companion materials to help stakeholders understand the details of the new guidelines.

Prevention is a cornerstone of the American Heart Association’s commitment to be relentless force for a world of longer, healthier lives. For example, the AHA funds innovative prevention-oriented research, advocates for stronger public health policies that promote healthier living and educates and equips both consumers and health care professionals to implement our prevention guidelines.

The new guidelines strengthen the evidence base and the business case for prevention, and clearly point out where we should be investing to achieve optimal health. I hope the new guideline will spark renewed stakeholder efforts to embrace prevention. The benefits of promoting health and quality of life are worth it!