Perspective:

The following are 20 points to remember about the European Guidelines on Cardiovascular Disease (CVD) Prevention in Clinical Practice:

1. Atherosclerotic CVD, especially coronary heart disease (CHD), remains the leading cause of premature death worldwide.

2. Prevention works: >50% of the reductions seen in CHD mortality relate to changes in risk factors, and 40% to improved treatments. Preventive efforts should be lifelong, from birth (if not before) to old age.

3. A risk estimation system such as SCORE can assist in making logical management decisions, and may help to avoid both under- and overtreatment. However, all risk estimation systems are relatively crude and require attention to qualifying statements.

4. While women appear to be at lower CVD risk than men, this is misleading, as risk is deferred by approximately 10 years rather than avoided.

5. CVD is by far the biggest cause of death in women. The risk of CVD in women, as in men, can be reduced by not smoking, by being active, avoiding overweight, and by having a blood pressure and blood cholesterol check (and intervention, if elevated).

6. The importance of the familial prevalence of early-onset CVD is not yet sufficiently understood in clinical practice.

7. Low socioeconomic status, lack of social support, stress at work and in family life, depression, anxiety, hostility, and the type D personality contribute both to the risk of developing CVD and the worsening of clinical course and prognosis of CVD.

8. High-sensitive C-reactive protein and homocysteine may be used in persons at moderate CVD risk.

9. Cognitive-behavioral methods are effective in supporting persons in adopting a healthy lifestyle.

10. Changing smoking behavior is a cornerstone of improved CVD health. Public health measures including smoking bans are crucial for the public’s perception of smoking as an important health hazard.

11. Energy intake should be limited to the amount of energy needed to maintain (or obtain) a healthy weight (i.e., a body mass index [BMI] <25 kg/m²). All-cause mortality is lowest with a BMI of 20-25 kg/m². Further weight reduction cannot be considered protective against CVD.

12. Participation in regular physical activity and/or aerobic exercise training is associated with a decrease in CV mortality.

13. Psychological interventions can counteract psychosocial stress and promote healthy behaviors and lifestyle.

14. Elevated blood pressure (BP) is a major risk factor for CHD, heart failure, cerebrovascular disease, peripheral arterial disease, renal failure, and atrial fibrillation.

15. Intensive management of hyperglycemia in diabetes reduces the risk of microvascular complications and, to a lesser extent, that of CVD. Intensive treatment of BP in diabetes reduces the risk of macrovascular and microvascular outcomes. Aspirin is no longer recommended for primary prevention in people with diabetes.

16. Increased plasma cholesterol and low-density lipoprotein cholesterol are among the main risk factors for CVD. Statin therapy has a beneficial effect on atherosclerotic CVD outcomes.

17. Adherence to medication in individuals at high risk and in patients with CVD is still low. Several types of interventions are effective in improving medication adherence. Evidence suggests that reducing dosage demands is the most effective single approach to enhancing medication adherence.

18. Risk factor screening including the lipid profile may be considered in adult men ≥40 years old and in women ≥50 years of age or post-menopausal. The physician in general practice is the key person to initiate, coordinate, and provide long-term follow-up for CVD prevention.

19. The practicing cardiologist should regularly review the discharge recommendations of the hospital after a cardiac event or intervention.

20. Cardiac rehabilitation is cost-effective in reducing risk of CV events.