Is An Asprin A Day, Still OK??

“A healthy lifestyle is the foundation upon which all else flows.”

Recently the ACC/AHA (American College of Cardiology/American Heart Association) published their latest guidelines. Most of the information was basically the same except the aspirin recommendation. This aspirin update has caused much confusion. Hopefully I can help. But first I want to help clear up the terminology.

So what is ASCVD? AtheroSclerotic CardioVascular Disease (ASCVD) is defined as arterial plaque buildup. ASCVD symptoms can mainfest as a non-fatal myocardial infarction (heart attack), stable or unstable angina, Stroke or TIA (mini-stroke), peripheral artery disease and aortic atherosclerotic disease (aortic aneurysm).

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There are other risk factor/behaviors that are associated with ASCVD. These include a history of diabetes, tobacco abuse, high blood pressure, obesity and a sedentary lifestyle.

Stop! What’s happening here you may start asking yourself? Why are so many things getting lumped into ASCVD? First ASCVD was defined as an arterial plaque buildup and the next thing you’re telling me is that ASCVD is also being sedentary- what gives?? That’s a good question.

ASCVD is an arterial plaque buildup. But what caused the build up in the first place? You guessed it…the risk factors. Well, we think it’s the risk factors in combination with genetics. But let’s stick with the things that we can control like diabetes, blood pressure, tobacco and obesity.

Now you’re starting to see the connection between risk factors and disease. If you control the risk factors then you can control the arterial plaque buildup. Controlling the arterial plaque buildup, controls ASCVD (stroke/heart attack). Are we all together? Good. Let’s move on to the new guidelines.

The ACC/AHA recently presented the 2019 guidelines on the primary prevention of cardiovascular disease. STOP! Translation? Let me say it a different way. The ACC/AHA released the recommendations on how to prevent you from ever having a heart attack or stroke.

“Primary” in this context means “you’ve never had it”. If you’ve already have a heart attack or stroke, the recommendation would say “secondary” prevention-meaning they want to prevent you from having the “2nd attack” (secondary)…get it?

So this new guideline is for primary prevention of cardiovascular disease (Never had it and don’t want it prevention) I’d like to give you the top Take Home Messages from the 2019 ACC/AHA for the Primary Prevention of CardioVascular Disease (ASCVD).

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A healthy lifestyle is the foundation upon which all else flows. The healthy diet includes daily intake of lean proteins, vegetables, fruits, nuts, whole grains and at least 64 ounces of water. The recommendation is to minimize or eliminate trans fat, red meats and processed meats. Limiting refined carbohydrates and sugar sweetened beverages is also recommended.

Adults who are 40-75 of age being evaluated for cardiovascular disease prevention should undergo a 10 year ASCVD risk estimation and have a consultation with your physician before starting any medical treatment.

For overwight/obese adults, counseling and caloric restriction are recommended to achieve and maintain weight loss.

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Adults should engage in at least 150 minutes a week of moderate intensity
physical activity or at least 75 minutes a week of vigorous intensity physical activity.

Adults with type 2 diabetes mellitus, lifestyle changes are crucial.

All adults should be assessed for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

Aspirin should be used infrequently in the routine primary prevention of ASCVD. Aspirin should not be used in adults age 70 or older for primary prevention. This is part of the new update change. If you’re taking aspirin for secondary prevention, then your physician will probably recommend that you continue the aspirin.

Aspirin should not be used in those with a high risk of bleeding. Remember this is for primary prevention. If you’ve had a heart attack, a stroke or you have heart stents, you need to keep taking your aspirin.

Statin therapy is the first line therapy for primary prevention of ASCVD in those with elevated low density lipoprotein cholesterol.

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The targeted blood pressure should generally be less than 130/80 mm Hg. Lifestyle changes remain the foundation of all adults with elevated blood pressure or hypertension.

As always, consult with your physician or health care provider before making any medical changes or starting any exercise program.

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Willette Davis

Willette Davis MD is a board-certified Internal Medicine physician with over 20 years experience. She has been part of the AMN family for many years. Her website is devoted to weight loss and optimal health. Willette is a Marketing University Platinum member.

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