New Guidelines to Reduce Risk of Atherosclerotic Cardiovascular Disease
Implications for Stroke Prevention in 2014
In November 2013, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines released 1 new statement on general cardiovascular risk assessment and 3 statements focused on reducing the risks of cardiovascular disease and stroke, including lifestyle management, treatment of blood cholesterol, and the management of overweight and obesity (the latter written in collaboration with The Obesity Society).1–4 A fifth statement on effective approaches to high blood pressure (BP) control, a collaboration among AHA, ACC, and the Centers for Disease Control and Prevention (CDC), also was published.5 In addition, in December 2013, separate guidance statements from the Eighth Joint National Committee (JNC 8) and the American Society of Hypertension/International Society of Hypertension for management and control of hypertension to minimize cardiovascular risk and complications were released.6,7 Each of the new statements is relevant to reducing the burden of stroke, and although they all represent a major step forward, they are not without controversy.
New Recommendations and Changes in Practice Guidelines
For the first time, risk prediction emphasizes both heart disease and stroke.1 The risk calculator is derived from pooled cohorts representing both whites and blacks in the US population who were followed for ≤12 years (for the atherosclerotic cardiovascular disease [ASCVD] risk calculator, see http://my.americanheart.org/cvriskcalculator). There has, however, been some concern that the ACC/AHA risk prediction algorithm overestimates risk by 75% to 150%, potentially leading to the unnecessary treatment of many patients with a statin.8 The prediction calculator has nonetheless been defended as a means of identifying people who might not otherwise be considered at risk, thereby prompting healthcare providers to optimize preventive behavioral strategies and other interventions.
The new guidelines simplify the approach to cholesterol lowering. Statin therapy is highlighted because there is less evidence that nonstatin drug treatment reduces the likelihood of cardiovascular …