The American College of Cardiology/American Heart Association (ACC/AHA) recently published new primary prevention of heart disease guidelines. The guidelines focus on traditional recommendations for managing conditions like atrial fibrillation (AFib), irregular heartbeat, and atherosclerosis (hardening or narrowing of arteries) that put someone at increased risk of heart attack and stroke.

New recommendations include for primary care providers to factor in social determinants that may hinder someone’s ability to live a heart-healthy lifestyle. The recommendations also include new guidelines for the use of daily aspirin to reduce the risk of heart attack. Western Connecticut Medical Group (WCMG) primary care and cardiology experts analyzed what the new guidelines mean.

The new guidelines come at a time when cardiovascular disease continues to be the leading cause of death in the United States. Recent data from the AHA found that nearly 50% of all American adults have some form of heart disease. Low-income groups are especially vulnerable to heart disease, and often the least able to make the lifestyle changes required to effectively manage their conditions.

Assessing physical, social, and economic risks

The ACC/AHA heart disease prevention guidelines still include diet and exercise recommendations. New suggestions include for primary care providers to identify specific social and economic factors, or social determinants, which may influence a patient’s ability to follow their treatment plan. Social determinants include barriers to health care, access to healthy foods, low health literacy, financial problems, cultural influences, psychosocial stress, and educational level. The underlying premise is that approximately 20% of health is determined by health care and roughly 80% is the result of these social determinants.

“Understanding the circumstances of a patient’s daily life can be just as important as writing them a prescription when trying to help them manage their heart disease. The new ACC/AHA guidelines encourage primary care providers to take cardiovascular risk assessment one step further by making sure patients have the tools and resources they need to follow their preventive care plan,” said Cornelius Ferreira, MD, FAAFP, network director of primary care for WCMG.

Preventive strategies and guidance

The new ACC/AHA guidelines recommend that primary care providers conduct routine cardiovascular disease risk assessments based on each patient’s age and health status.

Based on the results of the risk assessment, the guidelines suggest that primary care providers give patients the appropriate guidance on lifestyle modifications and managing chronic conditions to help prevent heart disease. The recommendations specifically address:

• Nutrition: People should follow a plant-based diet rich in vegetables, fruits, nuts, whole grains, and lean proteins
• Obesity: Overweight and obese people should participate in lifestyle-modification programs that combine a low-calorie diet with increased physical activity to promote weight loss
• Physical activity: Depending on age and other risk factors, most people should engage in at least 150 minutes of moderate-intensity physical activity each week (about 20 minutes per day), or 75 minutes of vigorous-intensity physical activity each week (about 10 minutes per day), including resistance training
• Type 2 diabetes: People with type 2 diabetes should participate in heart-healthy dietary counseling and follow the physical activity recommendations. If necessary, medication should be used to control blood sugar levels
• High cholesterol: People with high cholesterol should follow the nutrition and the physical activity guidelines too. If necessary, cholesterol-lowering medication should be used to manage cholesterol levels
• Blood pressure: People with high blood pressure should also follow the nutrition and physical activity guidelines, with a specific focus on lowering sodium intake and reducing alcohol consumption. If necessary, medications should also be used to lower blood pressure
• Tobacco use: Everyone should avoid all types of tobacco use. The ACC/AHA guidelines advise primary care providers to refer patients to smoking cessation specialists who can help them quit

A change in aspirin use recommendations

In a significant change, the new ACC/AHA guidelines state that low-dose aspirin should not be administered on a routine basis for primary prevention of heart disease among adults 70 years of age or older, or at any age in those who are at increased bleeding risk. Low-dose aspirin may be considered for primary prevention in certain adults between the ages of 40 and 70 who are not at increased risk for bleeding.

“With heart disease affecting such a high percentage of Americans, it is important that we continue to find new ways to communicate effectively with our patients and help them access the care they need,” said Michael Logue, MD, a WCMG cardiologist in Danbury and Norwalk, CT. “Overall, these strategies and guidelines provide a framework that will help health-care providers and patients share in decision-making about their health. Health-care providers and patients should work together toward the goal of preventing heart disease and living healthier lives.”