What is this about?

The American College of Cardiology (ACC) and the American Heart Association (AHA) have issued a new set of guidelines for the primary prevention of Cardiovascular Disease (CVD).  These recommendations provide an important background context for workplace wellness programming efforts to prevent heart disease among working Americans.  These guideline recommendations represent the best science we have to date to help reduce one of our most important causes of morbidity, premature mortality and healthcare utilization.

Major recommendations contained in this document include:

• A team-based care approach, including physicians and other clinicians, is effective for prevention of CVD (strong recommendation; high-quality evidence). Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions (strong recommendation; moderate-quality evidence).
• Adults aged 40 to 75 years being evaluated for CVD prevention should have a 10-year ASCVD risk estimation and a clinician-patient risk discussion before starting pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin (strong recommendation; moderate-quality evidence).
• Adults should be routinely counseled in health care visits to optimize a physically active lifestyle (strong recommendation; moderate-quality evidence).
• For adults with type 2 diabetes mellitus, lifestyle changes such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin should be used first (moderate recommendation; moderate-quality evidence), followed by consideration of a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a glucagon-like peptide 1 receptor (GLP-1R) agonist (weak recommendation; moderate-quality evidence).
• All adults should be assessed at every health care visit for tobacco use and tobacco use status recorded as a vital sign. Those using tobacco should be firmly advised to quit and assisted using a combination of behavioral interventions plus pharmacotherapy (strong recommendation; high-quality evidence).
• Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults aged 70 years or older (strong recommendation against routine use, moderate-quality evidence).

Why is this important?

This issue is important for 3 major reasons.  First, heart disease claims usually represent 10% to 17% of total health claims costs for most actuarially-sound working populations. This represents a significant savings potential if we can reduce the incidence of new heart disease by reducing the prevalence of relevant health risk factors.   Second, educating employees about these guidelines will likely help diffuse this knowledge more quickly through the health care system.  It is generally recognized that newer prevention science is usually slow to diffuse through the practitioner community. By educating employees we are likely to help primary care practitioners (PCPs) become aware and knowledgeable about the new guidelines. Third, the guidelines include the importance of lifestyle choices in the prevention of CVD, which helps support participation in employer wellness programs and the adoption of healthy lifestyle choices.

What can you do with this document?

• First, read the document to get a sense of the content and reasoning behind the guidelines.
• Next, determine where in your current programming this information could be utilized.
• Then, determine which of your program interventions should include this information first.
• Then, decide how else to include the information to help employees assimilate and use it with their PCP.
• Finally, make sure that any speakers, trainers, coaches or screening staff are aware of this information and appropriately reinforce its use.

In summary, this document contains a new set of guidelines for the prevention of CVD.  Employee wellness programs can play a major role in dissemination of this information in working populations.