Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patientoriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.html.

1. Use ankle-brachial index testing to assess for peripheral artery disease in patients with intermittent claudication or atypical ischemic leg symptoms.
Evidence rating: SORT A
Source: Section 1, references 3 and 4

2. Use a pooled cohort equation to estimate 10-year atherosclerotic cardiovascular disease risk for adults 40 to 75 years of age.
Evidence rating: SORT C
Source: Section 2, reference 1

3. Consider using coronary artery calcium scoring for patients with an intermediate risk of cardiovascular disease, as determined by a pooled cohort equation, to decide whether pharmacotherapy is needed.
Evidence rating: SORT C
Source: Section 2, references 20-22

4. In patients with chronic coronary disease and type 2 diabetes, recommend a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or a glucagonlike peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefits to reduce the risk of major adverse cardiovascular events.
Evidence rating: SORT A
Source: Section 3, references 2 and 20

5. To improve morbidity and mortality and reduce hospitalization rates in patients who have heart failure with reduced ejection fraction, initiate guideline-directed medical therapy within 12 weeks of diagnosis. Therapy should consist of an angiotensin receptor blocker/neprilysin inhibitor, an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker; a beta blocker (metoprolol succinate), carvedilol (Coreg), or bisoprolol; a mineralocorticoid receptor antagonist; and an SGLT-2 inhibitor.
Evidence rating: SORT A
Source: Section 4, references 2, 22, and 23

6. In patients who have heart failure with preserved ejection fraction and a body mass index of at least 30 kg/m2, strongly consider initiation of select GLP-1 receptor agonists tirzepatide or semaglutide.
Evidence rating: SORT A
Source: Section 4, references 40 and 41

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