What are the guidelines for preventative medicine in adults?

Adult Preventive Medicine Guidelines

Regular screening for cardiovascular disease risk factors and implementation of risk-based preventive interventions are essential for reducing morbidity and mortality in adults. 1

Cardiovascular Disease Prevention

Risk Assessment

• Adults aged 40-75 years should undergo regular cardiovascular risk assessment using the Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk 1
• Risk categories based on 10-year ASCVD risk:
  • Low risk: <5%
  • Borderline risk: 5% to <7.5%
  • Intermediate risk: 7.5% to <20%
  • High risk: ≥20% 1

Blood Pressure Screening and Management

• All adults should have blood pressure measured at regular healthcare visits
• BP classification:
  • Normal: <120/80 mmHg
  • Elevated: 120-129/<80 mmHg
  • Stage 1 hypertension: 130-139/80-89 mmHg
  • Stage 2 hypertension: ≥140/90 mmHg 1
• Treatment recommendations:
  • BP-lowering medications recommended for:
    • Adults with clinical CVD and BP ≥130/80 mmHg
    • Primary prevention in adults with 10-year ASCVD risk ≥10% and BP ≥130/80 mmHg
    • Primary prevention in adults with 10-year ASCVD risk <10% and BP ≥140/90 mmHg 1

Cholesterol Management

• Lipid screening recommended for all adults aged 40-75 years
• Statin therapy recommended for:
  • Adults aged 40-75 years with diabetes
  • Adults aged 40-75 years with 10-year ASCVD risk ≥10% and LDL-C 70-189 mg/dL 1
  • Adults aged 40-75 years with 10-year ASCVD risk 7.5-10% may be offered statins after shared decision-making 1

Cancer Screening

Breast Cancer

• Women aged 50-74 years: Mammography every 2 years
• Women aged 40-49 years: Individual decision based on risk factors and patient preferences

Colorectal Cancer

• Adults aged 45-75 years: Regular screening with colonoscopy (every 10 years), FIT (annually), or other approved methods

Cervical Cancer

• Women aged 21-29 years: Pap test every 3 years
• Women aged 30-65 years: Pap test every 3 years, or HPV testing every 5 years, or co-testing every 5 years

Lung Cancer

• Adults aged 55-80 years with ≥30 pack-year smoking history, currently smoking or quit within past 15 years: Annual low-dose CT scan 2

Diabetes Screening and Management

• Screen adults aged 35-70 years who are overweight or obese (BMI ≥25 kg/m²)
• For diagnosed diabetes, recommended preventive services include:
  • At least two A1C tests annually
  • Annual dilated eye examination
  • Annual foot examination
  • Annual cholesterol testing
  • Annual dental examination
  • Annual influenza vaccination 3

Immunizations

• Annual influenza vaccine for all adults
• Tdap/Td: Booster every 10 years
• COVID-19 vaccination according to current recommendations
• Pneumococcal vaccines for adults aged ≥65 years and high-risk younger adults
• Zoster vaccine for adults aged ≥50 years

Lifestyle Recommendations

• Follow the AHA's Life's Essential 8 1:
  1. Eat better (heart-healthy diet)
  2. Be more active (150+ minutes of moderate activity weekly)
  3. Quit tobacco
  4. Get healthy sleep (7-9 hours)
  5. Manage weight
  6. Control cholesterol
  7. Manage blood sugar
  8. Manage blood pressure

Special Considerations

Team-Based Care

• A team-based care approach is strongly recommended for controlling ASCVD risk factors 1

Older Adults (≥75 years)

• Preventive interventions should be individualized based on life expectancy, comorbidities, and patient preferences 1
• The USPSTF has issued an I statement (insufficient evidence) regarding initiating statin therapy for primary prevention in adults ≥76 years 1

Limitations of General Health Checks

• Evidence suggests general health checks do not reduce overall mortality or cardiovascular mortality 4, 5
• However, they may improve chronic disease detection, risk factor control, and preventive service uptake 5

Common Pitfalls to Avoid

1. Overreliance on risk calculators: PCE may overestimate or underestimate risk in certain populations. Use additional risk-enhancing factors for borderline or intermediate-risk patients 1

2. Neglecting shared decision-making: Risk assessment should initiate a conversation with patients about risk-reducing strategies, not be the sole factor for initiating pharmacotherapy 1

3. Focusing only on pharmacotherapy: Lifestyle modifications remain the foundation of preventive care for all risk levels 1

4. Overlooking social determinants of health: Stroke and cardiovascular disease disproportionately affect individuals facing adverse socioeconomic circumstances 1

5. Missing opportunities for prevention: More than half of stroke events could be prevented with better implementation of known risk factor control strategies 1