"For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," said North Carolina Cardiologist Dr. Kevin Campbell, who was not involved in the new guidelines. "This is the major difference, probably negating any previously perceived aspirin benefit in primary prevention."
Doctors may consider aspirin for some older high-risk patients, such as those who have difficulty lowering their cholesterol or managing their blood sugar, as long as there is no increased risk of internal bleeding, the guidelines say. European guidelines recommend the use of anti-clotting therapies such as aspirin at any age.
"Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease," John Hopkins, Cardiologist, Dr. Roger Blumenthal, who co-chaired the new guidelines, said in a statement. "It's much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin."
Using aspirin in younger age groups "is now a class 2b recommendation," Campbell said, "meaning that it is not necessarily "
However, personally, Campbell says he would" advocate a healthy lifestyle, smoking cessation and modification of risk factors before even considering aspirin therapy in a patient without known cardiovascular disease. "
"However, for anyone who has a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries, aspirin can be life-saving. on their individual situation, "Campbell said.
New research on aspirin
] "Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding," said Blumenthal.
The guidelines state that statins – along with lifestyle changes such as heart-healthy diet, regular exercise, weight loss and avoiding smoking or vaping tobacco – should be used to prevent heart disease in anyone with LDL levels of more than 190 milligrams per deciliter. LDL stands for low-density lipoprotein and is the "bad" cholesterol that clogs arteries and leads to heart disease.
Changing Type 2 Diabetes Recommendations
Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines stress a diet, exercise and weight control plan as the first line of offense. Strive for at least 150 minutes a week of moderate-intensity exercise, such as brisk walking and swimming, the guidelines say. Then, on another 75 minutes of high-intensity exercise, such as running and circuit training.
First-line medication should include metformin, the guidelines say. If additional medications are needed, two new classes of drugs are promising in reducing cardiovascular events in those with Type 2 diabetes: SGLT-2 inhibitors, which work to increase glucose and sodium removal via the kidneys; and GLP-1R agonists, which increase insulin and glucose production in the liver.
New research on these two classes of diabetes medications shows that they can also reduce the risk of heart attack, stroke and related deaths, 19659019]