From the Guidelines
The current management strategies for individuals at risk of or diagnosed with cardiovascular diseases and strokes should prioritize a combination of lifestyle modifications, medication therapy, and regular monitoring, as outlined in the 2024 guideline for the primary prevention of stroke from the American Heart Association/American Stroke Association 1.
Key Lifestyle Modifications
- Adopting a heart-healthy diet, such as the Mediterranean or DASH diet
- Engaging in regular physical activity, aiming for 150 minutes of moderate exercise weekly
- Maintaining a healthy weight
- Quitting smoking and limiting alcohol consumption
Medication Therapy
- Antihypertensives, such as ACE inhibitors (e.g., lisinopril 10-40mg daily), ARBs, calcium channel blockers, or diuretics, to maintain blood pressure below 130/80 mmHg
- Statins (e.g., atorvastatin 10-80mg or rosuvastatin 5-40mg daily) to lower LDL cholesterol to target levels based on risk stratification
- Antiplatelet therapy with aspirin (75-100mg daily) for secondary prevention
- Anticoagulants like apixaban (5mg twice daily) or warfarin for atrial fibrillation
Regular Monitoring
- Blood pressure checks
- Lipid panels
- Cardiac function assessments
- Risk stratification tools, such as the ASCVD Risk Calculator, to personalize treatment approaches
Additional Recommendations
- Blood glucose control is essential for diabetic patients, targeting HbA1c below 7% 1
- Vascular risk factor management, including treating hypertension to a goal of <130/80 mm Hg for most patients, and prescribing atorvastatin 80 mg/d if there is no major-risk cardiac course of embolism, no other indication for statin therapy, and LDL-C >100 mg/dL 1
These strategies work by addressing modifiable risk factors, reducing inflammation, preventing clot formation, and improving vascular function, ultimately decreasing the likelihood of cardiovascular events and improving long-term outcomes. The most recent and highest quality study, the 2024 guideline for the primary prevention of stroke 1, provides the foundation for these recommendations, emphasizing the importance of lifestyle modifications, medication therapy, and regular monitoring in managing cardiovascular diseases and strokes.
From the FDA Drug Label
To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD. Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD.
The current management strategies for individuals at risk of or diagnosed with cardiovascular diseases and strokes include reducing the risk of myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD).
- Key management strategies:
- Reducing the risk of MI and stroke in adults with type 2 diabetes mellitus and multiple risk factors for CHD
- Reducing the risk of non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD
- Using atorvastatin calcium tablets as an adjunct to diet to reduce low-density lipoprotein (LDL-C) in adults with primary hyperlipidemia, and adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH) or homozygous familial hypercholesterolemia 2, 2, 2
From the Research
Current Management Strategies for Cardiovascular Diseases and Strokes
The current management strategies for individuals at risk of or diagnosed with cardiovascular diseases and strokes involve a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications include dietary changes, increased physical activity, and smoking cessation 3.
- Pharmacological interventions include the use of lipid-lowering drugs, antihypertensives, antiplatelet, and anticoagulation therapies 3.
Pharmacological Interventions
Pharmacological interventions play a crucial role in the management of cardiovascular diseases and strokes.
- The use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers has been shown to be effective in reducing the risk of cardiovascular events 4, 5, 6.
- Statins have been shown to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) events in patients with hypertension and lipid disorders 5, 7.
- Aspirin has been shown to reduce the risk of ASCVD events, but it increases the risk of major bleeding 7.
Combination Therapy
Combination therapy with statins and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to be effective in reducing the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with coronary heart disease 6.
- The use of statin-angiotensin II receptor blocker combination therapy has been shown to be associated with a reduced risk of MACCEs compared to statin-angiotensin-converting enzyme inhibitor combination therapy 6.
Primary Prevention
Primary prevention of atherosclerotic cardiovascular disease (ASCVD) is crucial in reducing the risk of cardiovascular events.
- The use of aspirin, blood pressure-lowering therapy, statins, and tobacco cessation drugs has been shown to be effective in primary ASCVD prevention 7.
- The Million Hearts initiative emphasizes the importance of ABCS (aspirin for high-risk patients, blood pressure control, cholesterol level management, and smoking cessation) in primary ASCVD prevention 7.