Ascvd guidelines
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ASCVD Guidelines: A Comprehensive Overview
Primary Prevention of ASCVD and T2DM
Screening and Identification of Metabolic Risk
The primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) involves regular screening for metabolic risk factors. Health care providers should measure blood pressure, waist circumference, fasting lipid profile, and blood glucose to identify individuals at higher risk for ASCVD and T2DM. Those identified should undergo a 10-year global risk assessment for ASCVD or coronary heart disease to determine therapeutic targets for reducing apolipoprotein B-containing lipoproteins.
Lifestyle Management
Lifestyle management is the cornerstone of primary prevention. Behavioral programs should promote a heart-healthy diet, sodium restriction, daily physical activity, and weight loss of at least 5% of initial body weight within the first year. These changes should be supported by comprehensive programs led by trained interventionists and reinforced by primary care providers.
Pharmacological Interventions
When lifestyle modifications are insufficient, pharmacological and medical therapies can be employed. This includes treating hypertension to specific targets and using medications to manage blood glucose levels in individuals with prediabetes.
Stepwise Approach to Cardiovascular Disease Prevention
ESC 2021 Guidelines
The European Society of Cardiology (ESC) 2021 guidelines advocate a stepwise approach to managing cardiovascular risk factors in patients with established ASCVD. Step 1 includes smoking cessation, antithrombotic drugs, LDL cholesterol reduction to <1.8 mmol/L, and systolic blood pressure (SBP) control to 130-140 mmHg. For patients with T2DM, GLP1-receptor agonists or SGLT2 inhibitors are recommended.
Intensified Treatment Options
Step 2 involves more aggressive targets, such as reducing LDL cholesterol to <1.4 mmol/L and SBP to <130 mmHg, along with dual pathway inhibition and other advanced therapies. These intensified treatments significantly reduce residual cardiovascular risk, especially in high-risk patients.
Comparison of International Guidelines
ACC/AHA 2013 Guidelines
The American College of Cardiology (ACC) and American Heart Association (AHA) 2013 guidelines emphasize the importance of a healthy lifestyle and statin therapy for reducing ASCVD risk. Statins are recommended for adults with clinical ASCVD, high LDL-C levels, diabetes, or a 10-year ASCVD risk of 7.5% or higher. The guidelines also highlight the safety and efficacy of statins when used appropriately.
2018 AHA/ACC Cholesterol Guidelines
The 2018 guidelines further stratify patients to identify those at very high risk for ASCVD, recommending non-statin therapies for these individuals. This includes the use of cholesterol absorption inhibitors and PCSK9 inhibitors for patients who do not achieve LDL-C targets with statins alone.
2021 ESC Guidelines
The 2021 ESC guidelines incorporate environmental factors such as pollution into ASCVD risk assessment and emphasize the importance of lifestyle modifications across different populations, including older adults and those with comorbid conditions like diabetes and chronic kidney disease.
Lipid Management in China
2023 Chinese Guidelines
The 2023 Chinese guidelines for lipid management stress the importance of LDL-C as the primary target for lipid control. They recommend moderate-intensity statin therapy combined with a heart-healthy lifestyle as the initial treatment, followed by additional therapies like cholesterol absorption inhibitors or PCSK9 inhibitors if necessary. These guidelines aim to improve lipid management across various age groups to prevent ASCVD.
Conclusion
The prevention and management of ASCVD involve a multifaceted approach that includes lifestyle modifications, pharmacological interventions, and regular screening for risk factors. International guidelines from organizations like the ESC, ACC/AHA, and Chinese health authorities provide comprehensive strategies tailored to different populations and risk levels. By adhering to these guidelines, healthcare providers can significantly reduce the burden of ASCVD and improve patient outcomes.
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