PracticeUpdate Cardiology June 2019

CONFERENCE COVERAGE 20

2019 ASCVDGuidelines: General Approaches Interview with J. William McEvoy MB BCh BAO, MEHP, MHS, FRCPI by Aman Shah MD

Dr. Shah: We’re here at the ACC in New Orleans, and there have been updates in 2019 to the ASCVD guide- lines for primary prevention. Could you give us an overview of these guidelines? Dr. McEvoy: Yes, I’d be happy to. These are primary prevention guidelines, so they would contrast with the secondary prevention guideline, which are guidelines for patients who’ve had a history of CVD (cardiovascular disease) in the past. These guide- lines are specific to patients who have not had a history of CVD in the past, but who have risk for future events. The guidelines are very broad. They cover the whole range of CVD risk factors, inclusive of blood pressure, cholesterol, diabetes, as well as recommendations around aspirin and predicting, estimating CVD risk. They are an update that was much needed. The last primary prevention guideline was actually in 2002; the last one, at least from the ACC/AHA. And there has been more recent data, particularly around aspirin, as well as some cholesterol and diabetes data of quite substantial import that were in need of an update with these primary prevention guide- lines. So, they’ve been much anticipated and it’s been an interesting journey in compiling them and they’ve just been presented within the last hour at the meeting and also published simultaneously in Dr. McEvoy is Professor of Preventive Cardiology at the National University of Ireland and Consultant Cardiologist at the University College Hospital Galway. He also serves as Medical and Research Director of the National Institute for Preventive Cardiology in Ireland.

JACC (Journal of the American College of Cardiol- ogy) and in Circulation . Dr. Shah: Could you give us some top-line information on each of these different aspects from blood pressure to...? Dr. McEvoy: Yeah, I think probably the most newswor- thy and noteworthy recommendations were around aspirin. We will go into those, I think, in the next sec- tion, but aspirin has been an area of controversy and there have been recent trials, three large trials last year, that really make this quite a timely topic. Outside of aspirin, and again we’ll go into that in a little bit more detail, but outside of that, therewere recommendations around blood pressure, which largely were similar to recommendations from2017, which was the last blood pressure guideline released by ACC/AHA. For most intents and purposes, the recommen- dations carried forward. So, a blood pressure of 130/80 (mmHg) or higher is considered hypertension, and that’s a lower cut point than prior guidelines in terms of diagnosing hypertension and labeling some- body as having hypertension. And again, a treatment target of 130/80 is recommended as well for patients who have high CVD risk, or over 10% CVD risk over the next 10 years. For patients at lower risk, a target of 140/90 is recommended, and those were largely already in the 2017 guidelines. There wasn’t a sub- stantial amount of new data to inform the update in 2018 and, in the interest of maintaining consistency, most of the recommendations were similar. Dr. Shah: Okay, I want to focus on risk estimation. There are obviously several risk calculators. The guidelines

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