2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary

Arnett, Donna K.; Blumenthal, Roger S.; Albert, Michelle A.; Buroker, Andrew B.; Goldberger, Zachary D.; Hahn, Ellen J.; Himmelfarb, Cheryl Dennison; Khera, Amit; Lloyd‐Jones, Donald M.; McEvoy, John W.; Michos, Erin D.; Miedema, Michael D.; Muñoz, Daniel; Smith, Sidney C.; Virani, Salim S.; Williams, Kim A.; Yeboah, Joseph; Ziaeian, Boback

doi:10.1016/j.jacc.2019.03.009

Cited by 867 publications

(221 citation statements)

References 278 publications

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“…11,13 The 2019 ADA Standards of Medical Care in Diabetes, the 2019 American Association of Clinical Endocrinologists/American College of Endocrinology consensus report, and the 2019 American College of Cardiology/American Heart Association guidelines recommend consideration of SGLT-2i therapy with proven CV or renal benefit in patients with T2D and established CVD or CKD, with or without CVD. 11,13,121 8 | CONCLUSIONS…”

Section: Discussionmentioning

confidence: 99%

Effects of sodium‐glucose cotransporter‐2 inhibitors on the cardiovascular and renal complications of type 2 diabetes

Chilton

2019

Diabetes Obesity Metabolism

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Sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2is) have been shown to mitigate the risks of cardiovascular (CV) and renal complications in patients with type 2 diabetes (T2D) and CV risk factors or CV disease (CVD). In CV outcomes trials (CVOTs) of patients with T2D and established CVD or multiple CV risk factors, empagliflozin and canagliflozin were associated with significant reductions in the risks of major adverse CV events (MACE), hospitalization for heart failure (HF) and kidney disease progression. In the DECLARE–TIMI 58 study, in which the majority of patients did not have established CVD, dapagliflozin was associated with significant reductions in the composite end point of CV death or hospitalization for HF and was noninferior to placebo with regard to MACE; although patients had relatively good renal function, dapagliflozin also showed renal benefits similar to those seen with empagliflozin and canagliflozin. This article reviews the increased risk of CVD and renal disease in patients with T2D and discusses the potential mechanisms of the cardioprotective and renoprotective effects of SGLT‐2i therapy. The observed improvements in CV and renal outcomes with SGLT‐2is in CVOTs suggest a class effect in this patient population and have influenced treatment guidelines for the way add‐on therapy to metformin is initiated in patients with T2D and high CV risk. The overall cardioprotective and renoprotective effects of SGLT‐2is in patients with T2D and high CV risk are most likely attributable to multiple mechanisms, including cardiac, haemodynamic, metabolic, anti‐inflammatory and renal effects.

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Section: Discussionmentioning

confidence: 99%

Effects of sodium‐glucose cotransporter‐2 inhibitors on the cardiovascular and renal complications of type 2 diabetes

Chilton

2019

Diabetes Obesity Metabolism

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“…From the table of evidence in support of the recommendations of the 2019 ACC/AHA Guideline on the primary prevention of Cardiovascular Disease-A Report of the American College of Cardiology/American Heart Association Task Force on Clinical practice Guidelines [22], we extracted the two following examples (overall, in this guideline, there are dozens of original articles relying on a 0.005 < p < 0.05). The Multi-Ethnic Study of Atherosclerosis [23] demonstrated, among other things, that early menopause (below 46 years) is a moderate independent predictor of coronary heart disease and stroke in a diverse population of women in the USA.…”

Section: The Threshold For Significance and Its Originmentioning

confidence: 99%

Statistical significance: p value, 0.05 threshold, and applications to radiomics—reasons for a conservative approach

2020

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Here, we summarise the unresolved debate about p value and its dichotomisation. We present the statement of the American Statistical Association against the misuse of statistical significance as well as the proposals to abandon the use of p value and to reduce the significance threshold from 0.05 to 0.005. We highlight reasons for a conservative approach, as clinical research needs dichotomic answers to guide decision-making, in particular in the case of diagnostic imaging and interventional radiology. With a reduced p value threshold, the cost of research could increase while spontaneous research could be reduced. Secondary evidence from systematic reviews/metaanalyses, data sharing, and cost-effective analyses are better ways to mitigate the false discovery rate and lack of reproducibility associated with the use of the 0.05 threshold. Importantly, when reporting p values, authors should always provide the actual value, not only statements of "p < 0.05" or "p ≥ 0.05", because p values give a measure of the degree of data compatibility with the null hypothesis. Notably, radiomics and big data, fuelled by the application of artificial intelligence, involve hundreds/thousands of tested features similarly to other "omics" such as genomics, where a reduction in the significance threshold, based on well-known corrections for multiple testing, has been already adopted.

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“…Interventions to promote comprehensive ACP communications between patients and clinicians have resulted in improved patient and caregiver outcomes at the end of life. [1][2][3][4][5] Since primary care physicians (PCPs) share longitudinal relationships and engage in chronic disease management with patients, they are well positioned to participate and lead in ACP communications. 6 In 2016, barriers to ACP were remedied by the implementation of new reimbursement for ACP services delivered to Medicare beneficiaries.…”

Section: Primary Care Physician and Beneficiary Characteristics Assocmentioning

confidence: 99%

“…2 Results from this trial and other primary prevention studies, like A Study of Cardiovascular Events in Diabetes (ASCEND) and Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE), led the American Heart Association and American College of Cardiology to recommend against routine aspirin use for primary prevention in persons older than 70 years and those with increased bleeding risk. [3][4][5] Clinicians are left to implement these new recommendations with patients who may have been taking aspirin for its perceived health benefits for decades. To examine clinical practice patterns in the midst of these evolving guidelines, we developed an interprofessional (IP) approach to optimize aspirin use in our older adults, with a focus on deprescribing aspirin where appropriate.…”

mentioning

confidence: 99%

After ASPREE: Assessing Aspirin Usage in Older Adults Using an Interprofessional Approach

LaVine

Zhao

Coletti

et al. 2020

J American Geriatrics Society

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2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary

Cited by 867 publications

References 278 publications

Effects of sodium‐glucose cotransporter‐2 inhibitors on the cardiovascular and renal complications of type 2 diabetes

Effects of sodium‐glucose cotransporter‐2 inhibitors on the cardiovascular and renal complications of type 2 diabetes

Statistical significance: p value, 0.05 threshold, and applications to radiomics—reasons for a conservative approach

After ASPREE: Assessing Aspirin Usage in Older Adults Using an Interprofessional Approach

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