2016 European Guidelines on CVD Prevention
- Piepoli MF, Hoes AW, Agewall S, et al.
- 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by Representatives of 10 Societies and by Invited Experts). Eur Heart J 2016;May 24:[Epub ahead of print].
The following are key points to remember about the 2016 European Guidelines on Cardiovascular Disease (CVD) Prevention in Clinical Practice:
- Prevention of CVD, either by implementation of lifestyle changes or use of medication, is cost-effective in many scenarios, including population-based approaches and actions directed at high-risk individuals.
- Cost-effectiveness depends on several factors, including baseline CV risk, cost of drugs or other interventions, reimbursement procedures, and implementation of preventive strategies.
- Systemic Coronary Risk Estimation (SCORE), which estimates the 10-year risk of fatal CVD, is recommended for risk assessment and can assist in making logical management decisions and may help to avoid both under- and overtreatment. Validated local risk estimation systems are useful alternatives to SCORE.
- Several genetic markers are associated with an increased risk of CVD, but their use in clinical practice is not recommended.
- Routine screening with imaging modalities to predict future CV events is generally not recommended in clinical practice. Imaging methods may be considered as risk modifiers in CV risk assessment (i.e., in individuals with calculated CV risks based on the major conventional risk factors around the decisional thresholds).
- There is evidence of a positive relationship between obstructive sleep apnea syndrome and hypertension, coronary artery disease, atrial fibrillation, stroke, and heart failure.
- Erectile dysfunction is associated with future CV events in men without and with established CVD.
- Several obstetric complications, in particular pre-eclampsia and pregnancy-related hypertension, are associated with a higher risk of CVD later in life. This higher risk is explained, at least partly, by hypertension and diabetes mellitus (DM). Polycystic ovary syndrome confers a significant risk for future development of DM.
- CVD risk varies considerably between immigrant groups. South Asians and sub-Saharan Africans have a higher risk, while Chinese and South Americans have a lower risk. South Asians are characterized by a high prevalence and inadequate management of DM.
- Treatment of psychosocial risk factors can counteract psychosocial stress, depression, and anxiety, thus facilitating behavior change and improving quality of life and prognosis.
- Regular physical activity is a mainstay of CV prevention; participation decreases all-cause and CV mortality. Regular physical activity is recommended for all men and women as a lifelong part of lifestyle, with at least 150 minutes/week of moderate activity or at least 75 minutes/week of vigorous activity or an equivalent combination thereof. Any activity is better than none and more activity is better than some.
- Stopping smoking is the most cost-effective strategy for CVD prevention.
- Both overweight and obesity are associated with an increased risk of CVD death and all-cause mortality. All-cause mortality is lowest with a body mass index of 20–25 kg/m2 (in those <60 years of age); further weight reduction cannot be considered protective against CVD.
- Adherence to medication in individuals at high risk and in patients with CVD is low. Several types of interventions are effective in improving medication adherence. The polypill may increase adherence to treatment and improve CV risk factor control.
- Governmental and nongovernmental organizations such as heart foundations and other health-promoting organizations can be a powerful force in promoting a healthy lifestyle and healthy environments in CVD prevention.
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