A Clinician's Guide to the ABCs of Cardiovascular Disease Prevention: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative

Abstract

Atherosclerotic cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. Fortunately, it is often preventable with early adoption of lifestyle modification, prevention of risk factor onset, and aggressive treatment of existing risk factors. The Million Hearts Initiative is an effort by the Centers for Disease Control that aims to prevent 1 million myocardial infarctions and strokes over the next 5 years. As part of this initiative, we present a simply organized ''ABCDE'' approach for guiding a consistent comprehensive approach to managing cardiovascular risk in daily clinical practice. ABCDE stands for assessment of risk, antiplatelet therapy, blood pressure management, cholesterol management, cigarette/tobacco cessation, diet and weight management, diabetes prevention and treatment, and exercise, interventions regularly used to reduce cardiovascular (CV) risk. Throughout this article we summarize recommendations related to each topic and reference landmark trials and data that support our approach. We believe that the ABCDE approach will be the core framework for addressing CV risk in our effort to prevent CVD. IntroductionAtherosclerotic cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Fortunately, it is a condition ideally suited for prevention. CVD accounts for more than 2 million heart attacks and strokes in this country alone. It is also caused by risk factors that are readily modified by lifestyle change and inexpensive pharmacotherapy. As identified in the INTERHEART study (A Global Case-Control Study of Risk Factors for Acute Myocardial Infarction), 9 risk factors-smoking, dyslipidemia, diabetes mellitus (DM), hypertension, abdominal obesity, stress, poor diet, physical inactivity, and excess alcohol consumption-were associated with more than 90% of the risk for a first myocardial infarction (MI). 1 Finally, it takes decades to develop. In the wake of an MI or stroke, patients and clinicians alike often lament the presence of longstanding risk factors that may have been overlooked.

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“…Modifiable factors are related to more than 90% of the risk for a first heart attack (Hsu et al, 2013). Two of the most common CVD risk factors, obesity and abnormal lipid status, are described below.…”

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