The editorial board was composed of clinicians, cardiologists, health care researchers, epidemiologists, internists, nurses and a lay representative. The editorial board was composed of representatives from the CCA and the AHA. Annex 2 to this document lists the relevant members of the RWI Editorial Board. In the interest of full transparency, full disclosure information by members of the editorial board is available online. Living REGARDS participants or replacements are contacted by phone every six months to identify suspected cases of stroke, coronary artery disease (i.e., death from IMD or CHD) and heart failure, which are then reviewed against medical records (3,7). Stroke events are confirmed by a panel of neurologists as defined by the World Health Organization (8). Events that do not meet this definition but are characterized by symptoms that last <24 hours, with neuroimaging consistent with acute infarction or bleeding, are also classified as strokes. MIs and hospitalizations for heart failure are confirmed by clinicians trained according to published guidelines (9,10). When deaths are identified, trained clinicians determine the leading cause of death based on family interviews, medical records, death certificates and autopsy reports (10, 11). Cardiovascular events were defined as non-fatal or fatal stroke, non-fatal or fatal IMD, death from KHD, or hospitalization for heart failure. Cardiovascular events and all-cause mortality up to 31 December 2014 were available for this analysis. The turnover rate among REGARD participants was 2.9% per year. Since 2017, many changes to the guidelines have been and are being implemented to shorten the guidelines and increase "usability".â The guidelines are written and presented in a modular knowledge block format, in which each block contains a table with recommendations, a short summary, a recommendation-specific supporting text and, if necessary, additional organizational charts or tables.

Linked references are provided for each modular knowledge block to allow for quick access and review. More structured guidelines, including word limits (“objectives”) and an addition to the web guideline for useful but non-critical tables and figures, are 2 of these changes. This preamble is an abridged version, the detailed version of which is available online. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving eating habits and making exercise recommendations, are crucial. When drugs are indicated, metformin is a first-line treatment followed by consideration of a sodium-glucose-2 cotransporter inhibitor or glucagon-like peptide-1 receptor agon. Adults ≥ age 45 recommended initiating or intensifying antihypertensive drugs through the 2017 American College of Cardiology/American Heart Association blood pressure guideline and were at high risk of cardiovascular disease and all-cause mortality Despite the emphasis on moderate and vigorous physical activity, this activity represents a small part of the individual`s daily time compared to other forms of activity. Other activity states that extend over a 24-hour period for the average person include sleep, physical activity with light intensity, and sedentary behavior (Figure 1). Sitting behaviour refers to waking behaviour with an energy consumption of 1.5 metabolic equivalent when sitting or lying down (Table 4). S3.2-30 Increased sedentary behaviour is associated with poorer health outcomes, including cardiometabolic risk factors. S3.2-3, S3.2-9âS3.2-11 Sedentary behaviour may be most harmful to askwD risk for people who engage in the least moderate to vigorous physical activity. S3.2-3, S3.2-10, S3.2-12 Therefore, strategies to reduce sedentary behaviour, especially in people who do not achieve currently recommended levels of physical activity, may be beneficial in reducing the risk of ASCVD.

However, data on the value of reducing or modifying sedentary behaviour over time to reduce the risk of ASCVD are scarce, and it is not clear whether replacing sedentary behaviour with light-intensity activity (e.g. slow walking, light work) is beneficial for the prevention of ASCVD. S3.2-31 The strength and specificity of the recommendation to reduce sedentary behaviour is limited by uncertainty about appropriate limits and the optimal approach to modifying sedentary behaviour. S3.2-30 The clinician`s goal is to balance the intensity of prevention efforts with the absolute risk of a future ASCVD event and with the person`s willingness and ability to implement prevention strategies. The risk assessment is flawed and is based on group averages, which are then applied to individual patients. The clinician must balance understanding a patient`s estimated risk of ASCVD with the potential benefits and adverse risks of pharmacological treatment as part of a risk discussion. In order to determine the appropriateness of pharmacological treatment after a quantitative risk assessment in unclear cases, risk-increasing factors or selective use of calcium measurement in the coronary artery may influence decision-making for the use of cholesterol-lowering or antihypertensive drugs in people at medium risk. The growing need to consider value stems directly from the goal of achieving the best possible health outcomes with limited health resources in the primary prevention of cardiovascular disease.

S5-1The value of health care can be defined as the differential health benefit of a treatment or procedure relative to the long-term net incremental cost. Consideration of the cost and value of the guideline development process supports key objectives, including: 1) increasing the overall value of cardiovascular care delivery and 2) engaging health professionals in the difficult care decisions that need to be made to increase the value of the U.S. health care system. S5-2 The American Heart Association requests that this document be cited as follows: Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muã±oz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline for primary prevention of cardiovascular disease: a report from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:E596-646. DOI: 10.1161/CIR.00000000000000678 A team-based approach to nursing is an effective strategy for the prevention of cardiovascular disease.

Clinicians should assess the social determinants of health that affect individuals in order to make treatment decisions. This document was reviewed by 5 formal reviewers appointed by the CCA and AHA (1 reviewer by the ACC/AHA Working Group for Practice Guidelines, 2 reviewers by the AHA and 2 reviewers by the ACC); 3 reviewers on behalf of the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Society for Nutrition and the American Society of Preventive Medicine; and 23 individual content reviewers. Information on reviewers has been circulated to the Drafting Committee and is published in the present document (annex 3). The publication of this document has been approved by the governing bodies of the CCA and the AHA. Warnings: If the patient is at medium risk and a risk decision is uncertain and a coronary artery calcium score is reached, it is reasonable to suspend statin therapy unless higher risk conditions such as smoking, a family history of premature ASCVD or diabetes mellitus is present and the coronary artery calcium score is reassessed in 5 to 10 years. If calcium marking of coronary arteries is recommended, it should be done in facilities that have the latest technology and expertise to deliver the weakest possible radiation. All adults with hypertension are recommended for non-pharmacological treatment in accordance with the ACC/AHA BP 2017 guideline (1). Non-pharmacological therapies, including weight loss (24), a healthy diet (25.26), reduced dietary sodium intake (27.28), increased dietary potassium intake (29), physical activity (30-33) and moderate alcohol consumption (34.35), have been shown to lower blood pressure.