>> Hi, I'm Erin Michos
and I'm a co-author on the guidelines that we just released
that was put forward by the American College of Cardiology
and the American Heart Association
on the primary prevention of cardiovascular disease.
So primary prevention means individuals
who have not yet had clinical signs
of heart disease or a stroke
and we're trying to prevent that first event.
So what's new about these guidelines is that it takes pieces
from previous documents from the American Heart Association
about blood pressure treatment, cholesterol treatment,
diet, exercise, diabetes, and really puts it forward
into one document focused on primary prevention
that can be utilized for clinicians and for their patients.
So the current guidelines still emphasize
that the most important way
to prevent cardiovascular disease is
to follow a healthy lifestyle throughout one's life.
Additionally, when we're considering about drug therapy
for individuals aged 40 to 75,
the guidelines recommend using this risk calculator
put forward by the American Heart Association
to estimate one's 10 year risk for heart attacks or strokes.
And so based on that, it helps guide some decisions
such that if individuals are above 7.5% 10 year risk
of a heart attack or stroke,
generally statins are recommended for prevention.
However, what these new guidelines
and update is they're more personalized,
in that they also list a number of what they call
risk enhancing factors to consider
when making these statin decisions.
So these are factors that wouldn't be in that calculator.
They include things like autoimmune disease, HIV disease,
chronic kidney disease, having some abnormal biomarkers
such as a persistently elevated triglycerides,
elevated C-reactive protein, lipoprotein little a,
a number of things.
So when these risk enhancing factors are present,
this may strengthen the decision to initiate a statin
or if somebody is on a statin,
it may prompt you to consider intensifying
the therapy a little further.
But additionally, these new guidelines recognize
that in many cases the decision
to treat with a statin is still uncertain
and so when there is uncertainty,
sort of for a tie breaker, the guidelines recommend
using a coronary artery calcium score.
This is obtained by a cardiac CT.
And so for individuals who have a calcium score of zero,
so no evidence of calcified plaque in their heart arteries,
generally they're at low enough risk
over the next five to 10 years
that statin therapy can be deferred or postponed
if patients don't want to take it.
On the other hand,
if there is a significant calcified plaque
such as a coronary calcium score greater than 100
or above the 75th percentile for one's age,
that would further strengthen the recommendation
that statins would be recommended.
So the guidelines recommend estimating risk
and then personalizing it to make treatment decisions.
Initially they also say that individuals
that have diabetes should recommend a statin
sort of regardless of what their 10 year risk is
and also individuals who have really high LDL cholesterol,
above 190, would be recommended for statin.
So what else is new is sort of
that aspirin actually got a little bit of a de-emphasize
in the current guidelines.
So keep in mind that these are for primary prevention
so the guidelines don't change recommendation
for people who have known heart disease
so if you had a heart attack or you had a coronary stent,
aspirin is still recommended.
But in the current guidelines they indicate,
based on some recent trials
and the overall evidence that most healthy people,
aspirin therapy is not routinely recommended for prevention.
The risk of bleeding may outweigh any benefits
and so most individuals who are healthy
don't need to take an aspirin for prevention
but it still may be considered
in select high risk individuals
after discussion with one's doctor.
So in some, these guidelines really synthesize
previous documents that were put forward
and tries to put it all together to help clinicians
and their patients prevent
that very first heart attack or stroke event.
Thank you.