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Circulation Sep 2019
Review
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Topics: Advisory Committees; American Heart Association; Cardiology; Cardiovascular Diseases; Humans; Practice Guidelines as Topic; Primary Prevention; Research Report; United States
PubMed: 30879355
DOI: 10.1161/CIR.0000000000000678 -
Circulation Sep 20191. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A... (Review)
Review
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning. 4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults 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. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.
Topics: Advisory Committees; American Heart Association; Cardiology; Cardiovascular Diseases; Humans; Practice Guidelines as Topic; Primary Prevention; Research Report; Risk Reduction Behavior; United States
PubMed: 30879339
DOI: 10.1161/CIR.0000000000000677 -
The Lancet. Psychiatry Jul 2018Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated... (Review)
Review
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
Topics: Cost-Benefit Analysis; Humans; Mental Disorders; Primary Prevention; Risk Factors
PubMed: 29773478
DOI: 10.1016/S2215-0366(18)30057-9 -
Annals of Allergy, Asthma & Immunology... Jul 2020
Topics: Allergy and Immunology; Humans; Primary Prevention; Vaccines
PubMed: 32564925
DOI: 10.1016/j.anai.2020.03.031 -
The American Journal of Medicine Jan 2021
Topics: Aspirin; Humans; Platelet Aggregation Inhibitors; Primary Prevention; Sex Factors
PubMed: 32941847
DOI: 10.1016/j.amjmed.2020.08.014 -
Enfermedades Infecciosas Y... Sep 2018HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined...
HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined interventions. Early diagnosis and treatment of HIV-infected individuals is the most cost-effective strategy to control the epidemic, including interventions designed to motivate behavioural changes. These types of campaigns must not only be directed to the general population through mass channels, but also to key populations through more specific channels and messages. Biomedical interventions like pre-exposure prophylaxis, uses a combination of biomedical tools to reduce the risk of HIV acquisition, and are usually accompanied of behavioural interventions. The influence of structural factors, social justice and defending the rights of people living with HIV have a significant impact on prevention strategies. Structural interventions are designed to influence these factors that make some individuals or populations more vulnerable to HIV infection.
Topics: HIV Infections; Humans; Primary Prevention; Spain
PubMed: 30115406
DOI: 10.1016/S0213-005X(18)30244-1 -
The American Journal of Cardiology Nov 2014Recent guidelines for cholesterol management proposed by the American College of Cardiology (ACC) and American Heart Association (AHA) recommended statin therapy for...
Recent guidelines for cholesterol management proposed by the American College of Cardiology (ACC) and American Heart Association (AHA) recommended statin therapy for most men in their 60s and most women in their 70s. If these guidelines are followed in the United States, most adults will eventually take statins. A companion article in this journal goes a step further by proposing statin initiation for mostly everyone about 10 years earlier. Treatment in ACC/AHA guidelines does not depend on cholesterol levels, for either statin initiation or treatment goals. Selection of patients for statin therapy depends instead on multifactorial risk assessment derived from prospective studies in subgroups of the US population. Because of expansion of statin therapy, the issue of the reliability of risk assessment has come to the fore. Some evidence suggests that the ACC/AHA risk algorithm overestimates risk in many persons; if so, this would lead to statin therapy beyond what was intended. Some investigators favor assessment of risk based on presence or absence of categorical risk factors or higher risk conditions. Others propose selection of individuals for statin therapy grounded in measurement of atherosclerosis burden. Finally, an alternate approach to cholesterol management is to establish cholesterol goals for secondary and primary prevention. Cholesterol levels, and not global risk assessment, here define the intensity of therapy. The use of cholesterol goals allows more flexibility in treatment by taking advantage of lifestyle therapies and various drugs and their doses to attain defined goals.
Topics: Cardiovascular Diseases; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Primary Prevention
PubMed: 25245412
DOI: 10.1016/j.amjcard.2014.08.032 -
Current Problems in Pediatric and... Oct 2016
Topics: Child; Environmental Exposure; Humans; Leukemia; Primary Prevention; Risk Factors
PubMed: 27968953
DOI: 10.1016/j.cppeds.2016.08.003 -
Journal of General Internal Medicine Dec 2014Statins are the cornerstone of lipid-lowering therapy for cardiovascular disease prevention. The 2013 American College of Cardiology (ACC) and American Heart Association...
Statins are the cornerstone of lipid-lowering therapy for cardiovascular disease prevention. The 2013 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines represent a fundamental shift in how statins will be prescribed. The new guidelines recommend statins for nearly all older patients up to age 75 years, including healthy adults with low normal lipid levels and no atherosclerotic cardiovascular disease (ASCVD) risk factors other than age. Under the 2013 guidelines, age becomes a main determinant for initiating statin therapy for primary prevention among older adults. Specifically, according to the new guidelines, white males aged 63-75, white females aged 71-75, African American males aged 66-75, and African American females aged 70-75 with optimal risk factors would be recommended for statin treatment for primary prevention. Based on the new guidelines, one could term these older adults as having "statin deficiency," a condition warranting statin treatment. We call this putative condition of age-related statin deficiency "statinopause." After careful examination of the trial evidence, we find very little support for the new recommendations for primary prevention. The lack of evidence underscores the need for clinical trials to determine the risks and benefits of statin therapy for primary prevention among older adults.
Topics: Age Factors; Aged; Cardiovascular Diseases; Drug Prescriptions; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Practice Guidelines as Topic; Primary Prevention; Risk Assessment
PubMed: 25092007
DOI: 10.1007/s11606-014-2959-x -
International Journal of Stroke :... Jan 2017There is compelling evidence from the Global Burden of Disease (GBD) Study that the burden of stroke and cardiovascular disease (CVD) has been increasing fast over the...
There is compelling evidence from the Global Burden of Disease (GBD) Study that the burden of stroke and cardiovascular disease (CVD) has been increasing fast over the last two and half decades. These deficiencies are further highlighted by significant gender and ethnic disparities, and a trend towards more strokes in younger people. This suggests very strongly that currently used primary stroke and CVD prevention measures, which include high-risk (screening of the population for absolute CVD risk) and population-wide strategies, are not sufficiently effective. Identifying the causes of the failure in primary stroke and CVD prevention on individual and population levels and the most promising strategies to improve the situation is the first step in combating these leading causes of disease burden in the world.
Topics: Humans; Primary Prevention; Quality Improvement; Stroke
PubMed: 27681891
DOI: 10.1177/1747493016669850