Abstract
The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations. However, since all guidelines are based on a limited quantity of published studies and result from a consensus of experts in different fields of medicine, omissions and errors are inevitable. The present manuscript identifies four areas in these 2019 AHA/ACC guidelines that alternative approaches or changes would result in improved outcomes and reductions in atherosclerotic events. First, the goal for the reduction in the prevalence of cardiovascular disease should be total (100%) eradication of the disease. This is a feasible goal as the facilities and resources to accomplish this task are currently available. Second, guidelines should acknowledge that atherosclerosis is a reversible disease as has previously been documented by multiple studies. If reversible, then under the appropriate clinical circumstances, it is preventable. Third, the goal for LDL cholesterol reduction should be <50 mg/dl, if eradication of atherosclerosis is to be achieved. This goal is achievable and safe as suggested by published studies. Fourth, widespread use of the coronary artery calcium scan needs to be recommended so that early atherosclerosis can be reversed before a major cardiovascular event occurs. Treating all individuals at a specific risk category without regard for the presence of disease results in poor adherence to therapy and unnecessary side effects. Consideration of these four issues would improve the AHA/ACC guidelines and result in better patient care.
Highlights
In 2019, the American Heart Association/American College of Cardiology issued their latest guidelines (2019 AHA/ACC guidelines) for treating asymptomatic individuals to prevent atherosclerotic cardiovascular disease (ASCVD) [1]
The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations
The 2019 AHA/ACC guideline presents recommendations to prevent cardiovascular disease that are related to lifestyle factors, other factors affecting cardiovascular disease risk, patient-centered approaches, and considerations of the cost and value of primary prevention
Summary
In 2019, the American Heart Association/American College of Cardiology issued their latest guidelines (2019 AHA/ACC guidelines) for treating asymptomatic individuals to prevent atherosclerotic cardiovascular disease (ASCVD) [1]. Guidelines in general suffer from several deficiencies, including the choice of what data to review, the interpretation of scientific studies, and obtaining a consensus from a heterogeneous group of experts For this reason, cardiovascular guidelines from professional organizations rarely agree [2]. The 2019 AHA/ACC guidelines recommend a very limited use for coronary artery calcium scanning (CAC) in order to aid therapeutic decisions in intermediate level risk patients [1]. Additional information and details of the approach to eliminate cardiovascular disease can be found in references [4] and [8] Accomplishing this goal will require approximately five years and a commitment from healthcare providers, their institutions, and major organizations that support cardiovascular research and patient care.
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