Outcomes for people with atherosclerotic cardiovascular disease (ASCVD) have substantially improved in recent decades, yet ASCVD continues to be the leading cause of morbidity and mortality globally. A new American College of Cardiology/American Heart Association guideline consolidates existing recommendations and clinical practice guidelines into a single document on the primary prevention of ASCVD.

The guideline emphasizes the critical role of a healthy lifestyle-including a healthy diet, regular physical activity, and avoidance of tobacco-in primary prevention. It recommends a team-based, patient-centered approach, shared decision making, and consideration of social determinants of health. When deciding whether pharmacotherapy is needed, a patient's lifestyle and estimated risk of a future ASCVD event should be evaluated.

For adults 40 to 75 years, clinicians should routinely evaluate traditional risk factors and calculate 10-year ASCVD risk; for adults 20 to 39 years, risk factors should be assessed at least every four to six years. In young adults, statin therapy is indicated only in select individuals who have moderately or very high low-density lipoprotein cholesterol levels. Ten-year ASCVD risk should guide pharmacologic treatment in those ages 40 and older. Nonpharmacologic therapy is recommended to lower blood pressure in adults with hypertension, including in those who also require antihypertensive medication.

It's recommended that low-dose aspirin be used "infrequently" in the routine primary prevention of ASCVD. Its use may be justified in people ages 40 to 75 years who are at higher risk of ASCVD but not at increased risk for bleeding. For adults older than age 70, prophylactic aspirin is potentially harmful and shouldn't be used routinely.

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