Your doctor will ask you questions to determine your likelihood of developing CVD. Once your risk is established, you and your doctor can decide upon the strategies to take to prevent CVD. If your risk is borderline or intermediate, your doctor might recommend a coronary artery calcium (CAC) scan (a computed tomography test that can detect calcium deposits in your arteries) to help decide whether you should take a statin.
Your diet should be based around vegetables, fruits, legumes, whole grains, and small portions of nuts. Limit your intake of meat (especially processed meats like bacon and hot dogs). Try your best to eliminate refined carbohydrates (pasta, white rice), sweets, sweetened beverages, and added salt. Fish and shellfish can be a healthy choice as long as you vary the kinds you eat to minimize exposure to contaminants from pollution. Avoid trans fats and replace saturated fat with mono- and polyunsaturated fats. A Mediterranean-style diet, the DASH eating plan, and a balanced vegetarian diet are all good options.
Aim for a total of 150 minutes a week of moderate-intensity exercise (brisk walking, ballroom dancing, active yoga, leisurely biking) or 75 minutes a week of vigorous-intensity exercise (jogging, running, tennis, biking, swimming laps). If you’re not currently active, your doctor can help you plan reasonable starting goals, bearing in mind your general health. Keep in mind that even a little bit of daily physical activity, of any intensity, is better than none. And even very short bouts—less than 10 minutes, for instance—count toward your overall goal.
Being overweight or obese increases your risk of CVD. If you’re having difficulty losing weight, ask your doctor about participating in a medically supervised weight-loss program via phone or in person. The guideline suggests up to six months of counseling to help you establish new eating and exercise patterns.
A heart-healthy diet, aerobic exercise, and strength training can help you lose excess pounds and better control your blood sugar. If you need drug therapy, metformin (Glucophage, Glumetza, and generics) is typically the first line of treatment. Some people find it difficult to tolerate metformin because of its gastrointestinal side effects, such as diarrhea; taking it with food can help. If metformin and lifestyle changes don’t sufficiently improve blood sugar, the guideline recommends either SGLT2 (sodium-glucose cotransporter 2) inhibitors or GLP-1 (glucagon-like peptide 1) agonists. Both help reduce the risk of CVD.
Elevated LDL cholesterol (LDL-C) is a well-known risk factor for CVD. The guideline has specific LDL-C goals for people at high risk for CVD. If diet and exercise alone aren’t enough to lower your cholesterol, your doctor may prescribe a statin drug. In particular, statins are recommended if your LDL-C is 190 mg/dL or higher or if you have other risk factors, such as diabetes or a family history of CVD.
First-line treatments for high blood pressure are lifestyle changes: an improved diet; reducing sodium and alcohol; getting enough potassium, exercise, and sleep; and losing weight. The blood pressure goal for all adults is less than 130/80 mm Hg. If your systolic or diastolic blood pressure remains high despite lifestyle changes, antihypertensive drugs are recommended. If you already have high blood pressure and a 10-year, 10 percent CVD risk—or if you have chronic kidney disease—your recommended blood pressure goal is less than 130/80 mm Hg.
If you smoke and can’t quit on your own, ask your doctor about getting help from drug therapy and behavioral counseling. E-cigarettes are off limits, too; they emit nicotine and toxic gases and may increase CVD risk. Even exposure to secondhand smoke is a risk factor and should be avoided since it can increase your risk of CVD.
It's become increasingly unclear—and even doubtful—whether the cardiovascular benefits of a daily low-dose aspirin (usually 81 mg) outweigh its risks, namely stomach bleeding, in people who don't already have CVD (known as primary prevention). The new guideline addresses this, stating that aspirin "might be considered" for primary prevention in select higher-risk adults ages 40 to 70 who are not at increased bleeding risk, while people older than 70 or at increased bleeding risk should not take it. For more, see The Aspirin-A-Day Quandary.
Let your doctor know if any barriers are hindering your adoption of healthy habits. Poor-quality sleep, stress, financial strain, and family discord, for example, can get in the way of a healthy lifestyle and may in and of themselves put you at risk for CVD. Social barriers can include a lack of access to healthy food, transportation, a safe place to exercise, or social support.