Primary Prevention of Atherosclerotic Cardiovascular Disease (ASCVD) in Primary care: A Systematic Review of Guidelines

A systematic review of clinical practice guidelines (CPGs) for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) was conducted to assess the most effective strategies for reducing ASCVD risk.

The study highlighted the importance of regularly updating guidelines to incorporate new evidence, emerging risk factors, and novel therapies.

Main results

• New Risk Factors: The review emphasized the inclusion of emerging risk factors such as air pollution, sedentary lifestyle, and psychosocial stress, which have gained attention in recent studies. Integrating these into clinical practice guidelines can help address contemporary challenges in ASCVD prevention.
• Advances in Diagnostic Tools: Tools like coronary artery calcium scoring and genetic testing for familial hypercholesterolemia are increasingly relevant in identifying individuals at high risk. The study questioned whether these should be integrated into primary care practices for earlier detection and intervention.
• Emerging Therapies: New classes of drugs such as PCSK9 inhibitors and SGLT2 inhibitors show promise in preventing ASCVD. These therapies should be included in updated guidelines to optimize treatment for high-risk individuals.
• Variation in Guidelines: A significant variability was found among the 26 CPGs reviewed, particularly in risk assessment methods, non-pharmacological interventions, and pharmacological treatments. This inconsistency presents challenges for primary care physicians in implementing standardized care.
• Demographic and Clinical Sub-Populations: The review also focused on tailoring prevention strategies for specific populations, including the elderly, women, and those with conditions like diabetes and multimorbidity. Personalized approaches are essential for optimal ASCVD risk management.
• Lifestyle Interventions: Non-pharmacological interventions, such as behavioral counseling, physical activity, and dietary modifications, were consistently recommended across guidelines. However, the strength of these recommendations varied, especially regarding specific dietary patterns and exercise regimens.
• Pharmacological Interventions: Statin therapy was commonly recommended for high-risk patients, but there was considerable variability in when and how it should be prescribed. Non-statins, such as ezetimibe and fibrates, were also addressed, with mixed recommendations regarding their use in primary prevention.
• Consistency and Quality of Guidelines: Most guidelines were of high quality, but discrepancies in evidence grading and recommendations were noted. This highlights the need for greater harmonization in the development of clinical guidelines to ensure clarity and consistency.

Conclusion

Editorial comment

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