Primary cardiovascular prevention means intervening before a cardiac event has occurred. It involves identifying and modifying risk factors: hypertension, hyperlipidemia, diabetes, obesity, smoking, physical inactivity, and family history. The 10-year ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator integrates these factors into a percentage risk estimate that guides treatment decisions. A score ≥7.5% is typically the threshold for statin initiation in primary prevention.
Smoking cessation is the single highest-yield cardiovascular intervention available. Within 1 year of quitting, cardiovascular risk drops by 50%. Within 15 years, it approaches that of a non-smoker. No medication achieves equivalent risk reduction per dollar spent. Pharmacotherapy for cessation — varenicline (Chantix), bupropion, and nicotine replacement therapy — significantly improves quit rates and should be offered to every patient who smokes.
Exercise is profoundly cardioprotective. Current guidelines recommend 150 minutes per week of moderate-intensity aerobic activity (brisk walking, cycling, swimming) or 75 minutes of vigorous activity. Regular exercise reduces blood pressure, improves lipid profiles, decreases insulin resistance, and directly reduces cardiovascular mortality — effects that no pill fully replicates. Resistance training twice weekly provides additional metabolic benefit.
Aspirin for primary cardiovascular prevention has been largely abandoned in patients under 70 based on updated evidence showing that the bleeding risk now outweighs the cardiovascular benefit in low- to intermediate-risk patients. If you were told to take aspirin 'just in case' years ago, ask your doctor whether that recommendation still applies to you.