The New 2019 AHA/ACC Guideline on the Primary Prevention of Cardiovascular Disease

uch of the cardiovascular disease burden and mortality can be traced back to 4 adverse health behaviors (smoking, poor diet, elevated body mass index, and sedentary lifestyle) and 3 major risk factors (hypercholesterolemia, hypertension, and diabetes).Ideal cardiovascular health defined as having all 7 factors at goal is very rare among US adults.It is estimated that 87% of middle-aged US adults and 95% of individuals ≥60 years old meet ≤4 of these health metrics. 1 Detailed guidelines are available that discuss cardiovascular risk assessment, lifestyle management, and treatment of individual risk factors.Each one of these guidelines provides a superb summary of evidence-based care, but for busy practitioners, the number of guidelines and updates can be overwhelming.The new Primary Prevention Guideline 2 fills a critical gap by pulling together and updating, as appropriate, guidance on 9 topic areas: risk assessment, diet, exercise/ physical activity, obesity, type 2 diabetes, blood cholesterol, hypertension, smoking cessation, and aspirin use.Paramount is a patient-centered treatment paradigm that emphasizes team-based care, shared decision making, and the evaluation of social determinants of health.This Perspective highlights several key aspects of the new guideline.Given extensive coverage in the recent literature, recommendations for risk assessment, hypertension, and hypercholesterolemia are not reviewed.