New US prevention guidelines focus on overall risk of cardiovascular disease

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6858 (Published 14 November 2013)
Cite this as: BMJ 2013;347:f6858

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  1. Michael McCarthy
  1. 1Seattle

Four US expert panels have released a set of guidelines on prevention of cardiovascular disease that emphasize lifestyle factors and that substantially change the recommended approach to treating high blood cholesterol concentrations.

The guidelines were commissioned by the US National Health Lung and Blood Institute and drawn up by expert panels from the American Heart Association, the American College of Cardiology, and the Obesity Society.

The four guidelines deal with assessment of the risk of atherosclerotic cardiovascular disease; the treatment of high blood cholesterol concentrations; “heart healthy” lifestyles; and management of overweight and obese adults.

Heart disease and stroke are the leading causes of death and disability in the United States. It is estimated that about a third of US adults have elevated blood cholesterol, while a third have high blood pressure and another third are “pre-hypertensive” and at high risk of developing high blood pressure.

Currently, a quarter of people in the US over the age of 40 have been prescribed a cholesterol lowering hydroxymethyl glutaryl coenzyme A (HMG CoA) reductase inhibitor (statin).

The new risk assessment guideline uses a formula that is based on information easily collected in a primary care setting, such as age, cholesterol concentrations, blood pressure, smoking history, and diagnosis of diabetes. This information can then be entered into equations given in the guideline to create a risk score to guide patient counseling and, if warranted, treatment.1

The panel recommends that clinicians use the guideline’s risk assessment equations for patients aged 40-79 years. A person whose assessment indicates that they have a 7.5% or greater 10 year risk of cardiovascular disease is considered to be at high risk. The guideline provides a separate equation to estimate a person’s lifetime risk, which is recommended from age 20.

David C Goff, …

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