Risk factors for coronary disease and stroke are modifiable (eg, lipid disorders, hypertension, cigarette smoking) which are modifiable and those that are not are age, sex, family history of early coronary disease.
Impressive declines in age-specific mortality rates from heart disease and stroke were achieved in all age groups in North America from 1980 to 2015, in large part through improvement of modifiable risk factors: reductions in cigarette smoking, improvements in lipid levels, and more aggressive detection and treatment of hypertension.
| Prevention Method | Recommendation/[Year Issued] |
|---|---|
| Screening for AAA | Recommends one-time screening for AAA by ultrasonography in men aged 65–75 years who have ever smoked. (B) Selectively offer screening for AAA in men aged 65–75 years who have never smoked. (C) Current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65–75 years who have ever smoked or have a family history of AAA. (I) Recommends against routine screening for AAA in women who have never smoked and have no family history of AAA. (D) [2019] |
| Aspirin use | The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40–59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. [C] Recommends against initiating low-dose aspirin use for primary prevention of CVD in adults aged 60 years or older. [D] [2022] |
| Blood pressure screening | Recommends screening for hypertension in adults aged 18 years or older with office blood pressure measurement. Recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A) [2021] |
| Serum lipid screening and use of statins for prevention | Recommends that clinicians prescribe a statin for primary prevention of CVD for adults aged 40–75 years who have one or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater. [B] Recommends that clinicians selectively offer a statin for primary prevention of CVD for adults aged 40–75 years who have one or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. [C] Current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults aged 76 years or older. [I] [2022] |
| Counseling about healthful diet and physical activity for CVD prevention | Recommends offering or referring adults with CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (B) [2020] Recommends that primary care professionals individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (C) [2022] |
| Screening for diabetes mellitus | Recommends screening for prediabetes and type 2 diabetes in adults aged 35–70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions. (B) [2021] |
| Screening for smoking and counseling to promote cessation | Recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, provide those who use tobacco behavioral interventions, and prescribe US FDA–approved pharmacotherapy to nonpregnant adults. (A) [2021] |
USPSTF recommendations available at http://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations.
Recommendation A: The USPSTF strongly recommends that clinicians routinely provide the service to eligible patients. (The USPSTF found good evidence that the service improves important health outcomes and concludes that benefits substantially outweigh harms.)
Recommendation B: The USPSTF recommends that clinicians routinely provide the service to eligible patients. (The USPSTF found at least fair evidence that the service improves important health outcomes and concludes that benefits substantially outweigh harms.)
Recommendation C: The USPSTF makes no recommendation for or against routine provision of the service.