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AHA Scientific Sessions 2018 Highlights.

March 5, 2019 1335 This past November, over 14 000 attendees from more than 100 countries came to Chicago, IL, to take part in the 91st American Heart Association (AHA) Scientific Sessions. The meeting was a huge success, with over 4000 presentations delivered over the course of 3 busy fall days. Summarizing all that was covered at these sessions would be impossible, but we highlight a few select findings and major themes. Perhaps the biggest meeting highlight was the release of the 2018 AHA/American College of Cardiology/Multisociety Cholesterol Clinical Practice Guidelines. The new guidelines had several key revisions. Those with cardiovascular disease are now stratified by risk status. Those with very high risk are recommended to have their low-density lipoprotein cholesterol lowered using maximally tolerated statin therapy. If a low-density lipoprotein cholesterol <70 mg/dL is not achieved, then the addition of a nonstatin therapy (first ezetimibe, and then considering a PCSK9 inhibitor) is reasonable to achieve lower low-density lipoprotein cholesterol. For those without cardiovascular disease, the guidelines suggest that treatment decisions be tailored to an individual’s risk, using a framework of “CPR for prevention” (Calculate the risk, Personalize the risk, and Reclassify the risk if needed). The process starts with estimation of the 10-year risk for atherosclerotic cardiovascular disease using the Pooled Cohort Equations (available in AHA and American College of Cardiology apps and online). Clinicians and patients should then consider risk-enhancing factors, such as inflammatory illnesses, chronic kidney disease, early menopause, and even South Asian ethnicity, that may indicate a higher risk (and potentially greater benefit from statins). The guidelines stress that patients should play a central role in the decision-making process. For those patients who remain unsure whether to initiate therapy after clinical risk assessment, the guidelines suggest that coronary calcium scoring is useful to reclassify risk, specifically recommending that intermediate-risk patients (10-year risk of 7.5% to <20%) who have a coronary calcium score of 100 should receive a statin, whereas those with a calcium score of 0 may defer statin therapy. Overall, we see these guidelines as consistent with current best evidence, and they should lead to major advances in cardiovascular disease prevention. The Scientific Sessions also saw the release of a second major guideline document: the US Department of Health and Human Services 2018 Physical Activity Guidelines. This represents just the second time these guidelines have been published (the first was in 2008). The guidelines provide exercise recommendations for all ages. For adults, the guidelines mantra is move more and sit less throughout the day. The guidelines specifically recommend between 150 and 300 minutes of moderate aerobic physical activity or 75 to 150 minutes of vigorous aerobic physical activity each week. In addition, adults are encouraged to perform muscle-strengthening activities at least 2 days per week. We hope that these Eric D. Peterson, MD, MPH Donald Lloyd-Jones, MD, ScM