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Cardiology · AHA

Primary prevention of cardiovascular disease

AHA

A

Source:2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease (risk framework updated 2024 by PREVENT equationsBP and lipid arms updated 2025 and 2026)

Verified Apr 2026

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Red Flags

10-year PREVENT total-CVD risk ≥20% — high-risk; aggressive lipid lowering and BP control indicated regardless of symptoms^[2]
LDL-C ≥190 mg/dL — likely familial hypercholesterolaemia; high-intensity statin and family cascade screening^[1]
Diabetes with albuminuria or eGFR <60 — automatic high-risk regardless of calculated score; treat as secondary prevention equivalent^[1]
Strong family history of premature ASCVD (men <55, women <65) — risk-enhancing factor; lower threshold for statin^[1]

First-line treatment

Interventions

Lifestyle counselling^[1]
Mediterranean or DASH diet, ≥150 min/week moderate aerobic activity, weight reduction if BMI ≥25, sodium <2.3 g/day, smoking cessation, alcohol moderation
Smoking cessation^[1]
Behavioural counselling plus pharmacotherapy (nicotine replacement, bupropion, or varenicline) for all who smoke
Glycaemic management in diabetes^[1]
HbA1c target individualised (typically <7%); lifestyle plus metformin first-line; SGLT2 inhibitor or GLP-1 receptor agonist if established CVD or high CVD risk

First-line drug therapy

Drug	Class	Adult	Paediatric	Notes
Atorvastatin^[4]	HMG-CoA reductase inhibitor (statin)	10–20 mg PO daily (moderate-intensity, intermediate-risk primary prevention); 40–80 mg (high-intensity, LDL-C ≥190 or PREVENT risk ≥20%)	10 mg once daily for ages ≥10 with familial hypercholesterolaemia	First-line statin; 25–35% LDL-C reduction at moderate-intensity, 50%+ at high-intensity
Aspirin^[1]	Antiplatelet (low dose)	75–100 mg PO once daily	—	2019 update reversed routine primary-prevention aspirin: use ONLY in select adults 40–70 at higher ASCVD risk and lower bleeding risk; not recommended ≥70 years or any age with elevated bleeding risk

Atorvastatin^[4]

HMG-CoA reductase inhibitor (statin)

Adult: 10–20 mg PO daily (moderate-intensity, intermediate-risk primary prevention); 40–80 mg (high-intensity, LDL-C ≥190 or PREVENT risk ≥20%)
Paediatric: 10 mg once daily for ages ≥10 with familial hypercholesterolaemia

First-line statin; 25–35% LDL-C reduction at moderate-intensity, 50%+ at high-intensity

Aspirin^[1]

Antiplatelet (low dose)

Adult: 75–100 mg PO once daily
Paediatric: —

2019 update reversed routine primary-prevention aspirin: use ONLY in select adults 40–70 at higher ASCVD risk and lower bleeding risk; not recommended ≥70 years or any age with elevated bleeding risk

Safety-net

Statins are taken lifelong — stopping causes cholesterol and cardiovascular risk to rebound rapidly^[1]
Daily aspirin is no longer routinely recommended for prevention — discuss bleeding risk with your clinician before starting or stopping^[1]
Reassess your cardiovascular risk every 4–6 years, or sooner if your weight, blood pressure, or family history changes^[1]

Referral criteria

LDL-C ≥190 mg/dL or strong family history of premature ASCVD or tendon xanthomasLipid clinic for familial hypercholesterolaemia evaluation and family cascade screening^[4]
PREVENT 10-year total-CVD risk ≥20% AND uncertain about statin-vs-no-statinCardiology or preventive cardiology clinic for shared decision making and CAC scoring^[2]
Resistant or secondary hypertension suspected during preventive workupHypertension clinic; refer to dedicated hypertension guideline^[3]

Clinical summary

Risk-stratified prevention of atherosclerotic cardiovascular disease through lifestyle, lipid, BP, and glycaemic management in adults without known CVD.

References

1.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease (risk framework updated 2024 by PREVENT equations; BP and lipid arms updated 2025 and 2026) (2019)
2.Development and Validation of the American Heart Association's PREVENT Equations. Circulation (2024)
3.2025 AHA/ACC Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension (2025)
4.2026 ACC/AHA Guideline on the Management of Dyslipidemia. Circulation (2026)