"For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," said the North Carolina cardiologist. Kevin Campbell, who was not involved in the new guidelines. "This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention."
Doctors may consider aspirin for some elderly high-risk patients, such as those who have difficulty lowering their cholesterol or administering their blood sugar, as long as there is no increased risk of internal bleeding, the guide says. European guidelines recommend the use of anti-coagulation treatments such as aspirin of all ages.
"Clinicians should be very selective in prescribing aspirin to people without known cardiovascular disease," said John Hopkins cardiologist Dr. Roger Blumenthal, co-chair of the new guidelines, 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," said Campbell, "meaning that it is not necessarily the best course of action; there is much debate among experts and the data is not final."
But personally, Campbell says he "would advocate a healthy lifestyle, smoking cessation, and risk factor change before even considering aspirin treatment in a patient without known cardiovascular disease."
However, aspirin can be life-saving for anyone who has had strokes, heart attacks, open heart surgery or stents inserted to open clogged arteries.
"Ultimately, we need to individualize treatment for each patient based on their individual situation," Campbell said.
New research on aspirin
"Aspirin should be limited to people with the highest risk of cardiovascular disease and a very low risk of bleeding," Blumenthal said.
The guidelines emphasize that statins – along with lifestyle changes such as a heart-healthy diet, regular exercise, weight loss and avoid smoking or steaming tobacco – should be prevented from heart disease in anyone with LDL levels of more than 190 milligrams per day. deciliter. LDL stands for low density lipoprotein and is the "bad" cholesterol that clumps arteries and leads to heart disease.
Change of type 2 diabetes recommendations
Type 2 diabetes is a primary risk factor for cardiovascular disease, and the 2019 guidelines span a diet, exercise and weight control plan as the first offense line. Strive for at least 150 minutes a week with moderate intensity exercise, such as Fast walking and swimming, says the guide. Then thank you for another 75 minute high-intensity workout, such as running and circuit training.
First line medication should include metformin, the guidelines say. If additional drugs are required, two new classes of drugs show a promise to reduce 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 that increase insulin and glucose production in the liver.
New research on these two classes of diabetes medicine shows that they can also reduce the risk of heart attack, stroke and related deaths, the guidelines say.