Cardiovascular diseases (CVDs), including coronary heart disease (CHD) and stroke, represent two of the most important causes of morbidity and mortality in developed countries. Several risk factors increase the risk for coronary disease and stroke. These risk factors can be divided into those that are modifiable (eg, lipid disorders, hypertension, cigarette smoking) and those that are not (eg, age, sex, family history of early coronary disease). Impressive declines in age-specific mortality rates from heart disease and stroke have been achieved in all age groups in North America during the past two decades, in large part through improvement of modifiable risk factors: reductions in cigarette smoking, improvements in lipid levels, and more aggressive detection and treatment of hypertension. This section considers the role of screening for cardiovascular risk and the use of effective therapies to reduce such risk. Key recommendations for cardiovascular prevention are shown in Table 1–3. Guidelines encourage regular assessment of global cardiovascular risk in adults 40–79 years of age without known CVD, using standard cardiovascular risk factors. The role of nontraditional risk factors for improving risk estimation remains unclear.
Table 1–3.Expert recommendations for cardiovascular risk prevention methods: US Preventive Services Task Force (USPSTF).1 ||Download (.pdf) Table 1–3. Expert recommendations for cardiovascular risk prevention methods: US Preventive Services Task Force (USPSTF).1
|Prevention Method ||Recommendation/[Year Issued] |
|Screening for abdominal aortic aneurysm (AAA) || |
Recommends one-time screening for AAA by ultrasonography in men aged 65–75 years who have ever smoked. (B)
Selectively offer screening for AAA in men aged 65–75 years who have never smoked. (C)
Current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65–75 years who have ever smoked or have a family history of AAA. (I)
Recommends against routine screening for AAA in women who have never smoked and have no family history of AAA. (D)
|Aspirin use || |
Recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50–59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (B)
The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60–69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (C)
The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention ...