Pathways Forward in Cardiovascular Disease Prevention One and a Half Years After the Publication of the 2013 ACC/AHA Prevention Guidelines

摘要

The 2013 American College of Cardiology / American Heart Association (ACC/AHA) prevention guidelines represent an important step forward in both the risk assessment and management of atherosclerotic cardiovascular disease in clinical practice. Differentiated risk prediction equations for women and African Americans were developed, and convenient 10-year and lifetime risk assessment tools were provided, facilitating their implementation. Lifestyle modification was portrayed as the foundation of preventive therapy. In addition, based on high-quality evidence from randomized controlled trials, statins were prioritized as the first lipid-lowering pharmacologic treatment, and a shared decision-making model between the physician and the patient was emphasized as a key feature of personalized care. After their publication, however, important limitations of the guidelines were also identified. This resulted in a constructive scientific debate yielding valuable insights into potential opportunities to refine recommendations, fill gaps in guidance, and better harmonize recommendations within and outside the US. The latter point deserves emphasis because when guidelines are in disagreement, this may result in non-action on the part of professional caregivers or non-adherence by patients. In this review, we discuss the key scientific literature relevant to the guidelines published in the year and a half after their release. We aim to provide cohesive, evidence-based views that may offer pathways forward in cardiovascular prevention towards greater consensus and benefit the practice of clinical medicine.