By Jonathan Springston, Editor, Relias Media

The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released the 2019 Primary Prevention of Cardiovascular Disease guideline, which offers updated recommendations to help prevent heart disease and stroke.

Among the recommendations are several lifestyle changes, including advising patients to eat a healthier diet, exercise regularly, and avoid tobacco (including vaping and even breathing in any smoke).

“The most important way to prevent cardiovascular disease, whether it’s a build-up of plaque in the arteries, heart attack, stroke, heart failure, or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart-healthy habits and to do so over one’s lifetime,” said Roger S. Blumenthal, MD, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, in a statement. “More than 80% of all cardiovascular events are preventable through lifestyle changes; yet, we often fall short in terms of implementing these strategies and controlling other risk factors.”

Interestingly, the recommendations advise physicians to use caution when giving aspirin to healthy patients to help prevent heart attacks and stroke. While aspirin has demonstrated efficacy for those who have undergone open heart surgery or suffered a stroke, new research may cast doubt on using aspirin as a prevention tool.

In the November 2018 issue of Neurology Alert, Editor Matthew Fink drew attention to three articles about the effects of aspirin as primary prevention for cardiovascular disease in a cohort of healthy elderly patients. The authors found that using aspirin in those patients did not prolong disability-free survival over a five-year period; rather, there was a higher rate of major hemorrhages vs. patients who took placebo. Further, the authors concluded that using low-dose aspirin as primary prevention in elderly adults to reduce cardiovascular events, including stroke, did not result in a significantly lower risk of cardiovascular disease.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” Blumenthal said in his statement released with the ACC/AHA guideline. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin. Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”

Dr. Fink shares much more information about stroke prevention in this episode of the Rounds With Relias podcast. For much more about the ACC/AHA guideline, along with the latest research on cardiovascular and neurological health, be sure to check out Clinical Cardiology Alert and Neurology Alert