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.

Figure 1

The 10‐ vs 30‐year risk of hard cardiovascular CVD events (myocardial infarction, stroke, death) for 25‐year‐old women with different risk profiles. No risk factors profile: total cholesterol = 150 mg/dL; high‐density lipoprotein (HDL) cholesterol = 60 mg/dL; untreated systolic blood pressure (SBP) = 110 mm Hg; nonsmoker; nondiabetic. Adverse lipids: total cholesterol = 260 mg/dL; HDL cholesterol = 35 mg/dL. Hypertension: SBP = 160 mm Hg, untreated. From Pencina et al.10