New Canadian guideline for prevention and management of cardiovascular disease risk in primary care

Toward Optimized Practice (TOP) introduces a new practice guideline: Prevention and Management of Cardiovascular Disease Risk in Primary Care. By removing lipid targets and targeting instead the overall cardiovascular risk of the given patient, the management of lipids and cardiovascular disease risk has been significantly simplified.

Some of the key points include:

– Screen for cardiovascular disease (CVD) risk beginning at age 40 for men and 50 for women, always using a risk calculator with every lipid measurement to access risk. Consider earlier screening for patients with known traditional cardiovascular risk factors, such as hypertension, family history of premature CVD, smoking and diabetes.

– The document provides the following calculators as examples: The University of Edinburg Cardiovascular Risk Calculator; Best Science Medicine; and Qrisk2-2015.

– Fasting for lipid tests is NOT required.

– DO NOT target specific lipid levels and DO NOT repeat lipid level testing for a patient already on a statin. For patients not on lipid therapy reassess lipid levels no more than every five years, repeating screening sooner if other CV risk factors develop in the interim.

– DO NOT estimate risk in patients with pre-existing CVD (they are classified high-risk) and DO NOT estimate risk in patients less than 40 year of age without identified risk and those over 75 years of age.

– Discuss lifestyle interventions with all patients.

– Discuss the risks and benefits of moderate or high intensity statins with primary prevention patients based on an individual’s risk of CVD: for patients with a 10-year CVD risk of < 10% re-test lipids in five years with risk estimation; For patients with a 10-year risk of 10-19% discuss and offer statins (preferably moderate intensity); and for patients with a 10-year CVD risk > or = 20% discuss and strongly encourage statins (preferably high intensity).

– Discuss the risks and benefits in order to strongly encourage high intensity statin therapy with secondary prevention patients.

– DO NOT use non-statin lipid lowering drugs in primary prevention as a first-line monotherapy or in combination with statins.

– Consider acetylsalicylic acid only after statin therapy in high-risk individuals with a 10-year CVD risk > or = 20% and with a low risk of bleeding.

Links to related files are freely available from the TOP Website:

Summary with algorithm– Prevention and Management of CVD Risk in Primary Care.

Guideline – Prevention and Management of Cardiovascular Disease Risk in Primary Care.

Patient Information – Reducing Your Risk for Heart Attacks & Strokes.

Background Evidence – Prevention and Management of Cardiovascular Disease Risk in Primary Care: Evidence Review of 12 Key Questions.