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CVDs, including 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 from 1980 to 2015, 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. However, the past several years have seen a disturbing increase in cardiovascular deaths in the United States and leveling off of the reduction in cardiovascular mortality rates. 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 1–4. 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 1–4.Expert recommendations for cardiovascular risk prevention methods: USPSTF.1

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