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

The 2019 guideline is the American counterpart to the ESC 2021 prevention document, and the two differ mainly in how risk is quantified and how aggressively aspirin is abandoned. Risk here rests on the Pooled Cohort Equations plus 'risk-enhancing factors' and, in the borderline-to-intermediate range, a coronary artery calcium score — where the ESC uses SCORE2/SCORE2-OP and no routine calcium scoring. Aspirin for primary prevention is downgraded to a narrow, selectively applied option (Class IIb, and Class III: Harm above 70 years) on the strength of ASCEND, ASPREE and ARRIVE. Blood pressure is treated to <130/80 mmHg and statins are prescribed by risk category rather than to an LDL-C target. Because the document closed in 2019, later prevention landmarks appear in a separate section below.

This guideline cites 6 of the 199 landmark trials in our Cardiology register.

Source

Arnett DK, Blumenthal RS, et al. Circulation. 2019;140(11):e596–e646.

DOI

10.1161/CIR.0000000000000678