Reviewing the Updated ABCs of Cardiovascular Disease Prevention, With Aaron Troy, MD, MPH

The ABCs of Cardiovascular Disease (CVD) Prevention, initially published in 2001 as a method to identify and address the various aspects of prevention for patients and clinicians, has recently undergone a major update.1

At the American College of Cardiology (ACC) Scientific Sessions 2026, in New Orleans, Louisiana, the HCPLive editorial team met with Aaron Troy, MD, MPH, clinical research fellow in cardiovascular medicine at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, to discuss the recent changes and how they can impact 1 of the most prominent disease states in the US.

“This is a profound opportunity for everyone in the United States across cardiology subspecialties and internal medicine to really reconsider and optimize our cardiovascular disease prevention for patients overall,” Troy told HCPLive in an exclusive interview. “That’s really the impetus for the updated ABCs. They’re a framework for summarizing the core tenets of preventive cardiology.”

Currently, the ABCs of CVD Prevention are broken into 6 main letters, which are in turn composed of 2 recommendations each. The full list is as follows:

• A
  • Assess CVD Risk (Life’s Essential 8, PREVENT, risk enhancers)
  • Antiplatelets (consider in high-risk primary prevention, prescribe for secondary)
• B
  • Blood Pressure (target <130/80 mmHg, close follow-up & home monitoring)
  • Body Fat (measure waist, assess complications, target >5% weight loss)
• C
  • Cholesterol (assess regularly in all life stages, consider combination therapy)
  • Cigarettes & Alcohol
• D
  • Diet (Mediterranean, DASH, plant-based, calorie deficit)
  • Diabetes and CKM Syndrome (screen with A1c, eGFR, UACR, target CKM with SGLT2i, GLP-1 RAs)
• E
  • Exercise (>150 minutes/week, resistance training >2x/week)
  • Extend Healthspan (assess physical & cognitive function, multidisciplinary care, cardiac rehab)
• F
  • Heart Failure (Identify & optimize in Stage B HF, GDMT in Stage C HF)
  • Atrial Fibrillation (anticoagulate for CHA2DS2-VASc ≥2-3, consider early rhythm control)1

The new document emphasizes the importance of the PREVENT equations, which were formulated using a larger and more contemporary population than the widely utilized Pooled Cohort Equations (PCEs). The recalibration of these equations resulted in a 10-year risk estimate roughly 40-50% lower than the PCE – this highlights the need for personalized approaches to avoid undertreating patients.1

Additionally, Life’s Essential 8 once again takes center stage in CVD, with the health behavior checklist encompassing almost every avenue by which CVD can occur. Patients are encouraged to improve their sleep schedules, exercise regimens, and diet, with specific, targeted goals provided within the framework. Additionally, lipids, glucose, and blood pressure are spotlighted as major contributors to CVD, leading to greater emphasis on their reduction.1,2

Notably, the new ABCs also include the traditionally disease-focused areas of heart failure and atrial fibrillation. The document recommends that clinicians identify patients with stage B heart failure and prevent their progression to stage C, as well as treating stage C heart failure to prevent further hospitalizations and mortality. Atrial fibrillation, meanwhile, is the most common cardiac arrythmia in the US despite modifiable risk factors – the new ABCs encourage clinicians to optimize these risk factors and prevent the increased morbidity and mortality associated with the condition.1

Troy also discussed the importance of the updated framework, noting the shortcomings currently facing cardiovascular care in the US.

“The time has come for a new and improved – and sort of streamlined – framework to optimize cardiovascular disease prevention,” Troy said. “The levels of hypertension awareness, hypertension control, cholesterol control, really everything is suboptimal on a national level, and with the obesity epidemic driving cardiovascular-kidney-metabolic disease and population aging, the patient landscape is evolving.”

Editors’ Note: Troy reports a disclosure with the American Academy of Home Care Medicine.

References

1. Goren LR, Peng AW, Razavi AC, Blaha MJ, Blumenthal RS, Troy AL. The ABCs of Cardiovascular Disease Prevention: Communicating What We Know in 2026. American Journal of Preventive Cardiology. Published online March 20, 2026:101570. doi:10.1016/j.ajpc.2026.101570

2. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s essential 8: Updating and enhancing the American Heart Association’s construct of Cardiovascular Health: A presidential advisory from the American Heart Association. Circulation. 2022;146(5). doi:10.1161/cir.0000000000001078