Tuesday, 19 June 2018

Statin Therapy for Primary Prevention of CVD in Adults - USPSTF 2017 Guidelines


Patient Population
Recommendation
Grade of recommendation
40 to 75 years with no history of CVD, ≥ 1 CVD risk factors*, and calculated 10-year ASCVD ≥ 10%
low- to moderate-dose statins.
B
40 to 75 years with no history of CVD, ≥ 1 CVD risk factors*, and calculated 10-year ASCVD 7.5% to 10%
Can consider low- to moderate-dose statins after discussion with patient
C
Adults 76 years and older with no history of CVD
No recommendations
I


* LDL-C > 130 mg/dL or HDL-C < 40 mg/dL), diabetes, hypertension, and smoking

Statin Therapy for ASCVD Prevention - 2014 ACC/AHA Updated Guidelines



Patient Population
Recommendations
Grade of Recommendation - Level of evidence
Age ≤ 75 years with ACS or a history of MI, stable or unstable angina, PCI, stroke, TIA, or PAD
High-intensity statin
I-A
Age > 75 years with ACS or a history of MI, stable or unstable angina, PCI, stroke, TIA, or PAD
Moderate-intensity statin
I-A
Patients of Age ≥ 21 years with primary LDL-C ≥ 190 mg/dL
High-intensity statin
I-B
40 to 75 years of age with DM and LDL-C of 70 to 189 mg/dL
Moderate-intensity statin
I-A
40 to 75 years of age with DM and LDL-C of 70 to 189 mg/dL with ≥ 7.5% 10-year ASCVD risk
High-intensity statin
IIa-B
40 to 75 years of age without diabetes and with LDL-C of 70 to 189 mg/dL and
≥ 7.5% 10-year ASCVD risk
Moderate or high-intensity statin
I-A
40 to 75 years of age without diabetes and with LDL-C of 70 to 189 mg/dL and 5% to < 7.5% 10-year ASCVD risk
Moderate-intensity statin
IIa-B

Thursday, 14 June 2018

Management of High Blood Pressure in Adults - 2017 ACC/AHA Guidelines


Blood Pressure category
Recommendation
Class of Recommendation
Normal (< 120 mm Hg)
Lifestyle modification and recheck in 1 year
Class IIa
Elevated (120-129 mm Hg)
Nonpharmacological therapy and reassess in 3-6 months
Class I
Stage I Hypertension
(130-139 mm Hg) WITHOUT clinical ASCVD or estimated 10y CVD risk ≥ 10%

Nonpharmacological therapy and reassess in 3-6 months

Class I
Stage I Hypertension
(130-139 mm Hg) WITH clinical ASCVD or estimated 10y CVD risk ≥ 10%
Nonpharmacological therapy and BP lowering medications.
Reassess in 1 months

Class I

Stage II Hypertension (≥140 mm Hg)
Nonpharmacological therapy and BP lowering medications
(2 agents of different classes).
Reassess in 1 months
Class I



Blood Pressure (BP) Thresholds and Recommendations for Treatment and Follow-Up, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary.


Source

Blood Pressure Categories in Adults - 2017 ACC/AHA guidelines

Division of BP as per the 2017 ACC/AHA guidelines


Blood Pressure category
Systolic Blood Pressure
Diastolic Blood Pressure
Normal
< 120 mm Hg
< 80 mm Hg
Elevated
120-129 mm Hg
< 80 mm Hg
Stage I Hypertension
130-139 mm Hg
80-89 mm Hg
Stage II Hypertension
≥140 mm Hg
≥90 mm Hg

2017 ACC/AHA/ .. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. Source

Coronary Angiography for suspected Stable Ischemic Heart Disease - ACC/AHA 2014 Focus Guidelines

Coronary Angiography for Diagnosis of Coronary Artery Disease in Patients With Suspected SIHD: 2014 ACC/AHA Recommendations


Patient Population
Recommendation
Grade / Level of Evidence
Suspected Ischemic heart disease symptoms despite guidelines directed medical therapy
Perform Coronary Angiography
Class I / C
High likelihood of severe IHD on noninvasive testing (exclusive of stress testing)
Coronary angiography is reasonable
Class IIa / C
suspected symptomatic stable
IHD patients who cannot undergo
diagnostic stress testing
Coronary angiography is reasonable
Class IIa / C
High clinical suspicion of CAD with negative stress test results
Coronary angiography might be considered
Class IIb / C

2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Source

Aspirin for Primary Prevention - Current 2016 USPSTF Guidelines

USPSTF Guidelines for primary prevention with Aspirin




Patient Population
Recommendation
Level of evidence
Adults aged 50 to 59 years with a ≥10% 10-year CVD risk
Initiate low-dose aspirin use
Grade B
Adults aged 60 to 69 years with a ≥10% 10-year CVD risk
Individualized decision to start low-dose aspirin
Grade C
Adults younger than 50 years
No Recommendation
Grade I (insufficient evidence)
Adults aged 70 years or older
No Recommendation
Grade I (insufficient evidence)

Final Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication. U.S. Preventive Services Task Force. September 2017. Source