Clinical Preventive Service Recommendation

Cardiovascular Disease

Cardiovascular Disease, Genomic Testing

The AAFP recommends against genomics profiling to assess risk for cardiovascular disease. The net health benefit from the use of any genomic tests for the assessment of cardiovascular disease risk is negligible and there is no evidence that they lead to improved patient management or increased risk reduction. (2012)

Clinical Consideration(www.nature.com)

Coronary Heart Disease, Adults

Grade: D recommendation

The AAFP recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. (2012)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Coronary Heart Disease, Adults

Grade: I recommendation

The AAFP concludes that the current evidence is insufficientto assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events. (2012)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Coronary Heart Disease Risk Assessment, Using Nontraditional Risk Factors

Grade: I recommendation

The AAFP concludes that the current evidence is insufficientto assess the balance of benefits and harms of using the nontraditional risk factors discussed in this statement to screen asymptomatic men and women with no history of CHD to prevent CHD events. (Select "Clinical Considerations" for suggestions for practice when evidence is insufficient).

The nontraditional risk factors included in this recommendation are high-sensitivity C-reactive protein (hs-CRP), ankle-brachial index (ABI), leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness (carotid IMT), coronary artery calcification (CAC) score on electron-beam computed tomography (EBCT), homocysteine level, and lipoprotein(a) level. (2010)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Behavioral Counseling to Promote a Healthful Diet and Physical Activity to Prevent Cardiovascular Disease in At-Risk Adults

Grade: B recommendation

The AAFP recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD. (2014)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Consideration(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)s

Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Risk Factors: Behavioral Counseling:

Grade: C recommendation

The AAFP recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose, or diabetes to behavioral counseling to promote a healthful diet and physical activity. (2017)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of cardiovascular disease (CVD) in this population. Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling.

Hypertension, Adults

Grade: A recommendation

The AAFP recommends screening for high blood pressure in adults aged 18 years or older. The AAFP recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (2015)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Consideration(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Hypertension, Children and Adolescents

Grade: I recommendation

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms for screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood. (2013)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Consideration(annals.org)(annals.org)

Lipid Disorders, Adults

Grade: B Recommendation
Adults 40-75 years with no symptoms or history of CVD and a calculated 10-year CVD event risk of 10% or greater

The AAFP recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are aged 40 to 75 years; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater.

Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75 years.

See Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org) for more information on lipids screening and the assessment of cardiovascular risk. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Grade: C Recommendation
Adults 40-75 years with no symptoms or history of CVD and a 10-year CVD event risk of 7.5%-10%

Although statin use may be beneficial for the primary prevention of CVD events in some adults with a 10-year CVD event risk of less than 10%, the likelihood of benefit is smaller because of a lower probability of disease and uncertainty in individual risk prediction. Clinicians may choose to offer a low- to moderate-dose statin to certain adults without a history of CVD when all of the following criteria are met: 1) they are aged 40 to 75 years; 2) they have one or more CVD risk factors (i.e., d dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 7.5% to 10%. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)
Clinical Consideration(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Grade: I Recommendation
Adults 76 years and older with no history of CVD

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use for the primary prevention of CVD events and mortality in adults 76 years and older without a history of heart attack or stroke. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)
Clinical Consideration(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Lipid Disorders, Children and Adolescents 20 Years or Younger

Grade: I Recommendation

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms for screening of lipid disorders in children and adolescents 20 years or younger. (2016)

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)
Clinical Consideration(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Peripheral Arterial Disease

Grade: I recommendation

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk assessment with the ankle-brachial index (ABI) in adults.

Grade Definition(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)

Clinical Considerations(www.uspreventiveservicestaskforce.org)(www.uspreventiveservicestaskforce.org)


These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.