Guidelines on the prevention of cardiovascular disease (CVD) from the Fourth Joint Task Force improve the SCORE absolute risk calculation and add a simple relative risk chart for younger patients. Gender issues, central obesity, HDL cholesterol, heart rate, renal impairment, diabetes and manifestations of CVD other than coronary heart disease receive detailed attention.
More emphasis is given to starting with lifestyle modification, particularly physical activity and exercise, smoking cessation and weight management. Indication of therapies such as use of statins, antiplatelet therapies and antithrombotic strategies, ACE inhibitors and beta-blockers are made clear.
Treatment goals are more rigorous....
Treatment goals are more rigorous, particularly for those with established atherosclerotic CVD and diabetes:
1. Blood pressure <130/80 mmHg;
2. Total cholesterol <4.5 mmol/l (~175 mg/dl), with an option of <4 mmol/l (~155 mg/dl) if feasible, and
3. LDL-cholesterol of <2.5 mmol/l (~100mg/dl), with an option of <2.0 mmol/l (~80 mg/dl) if feasible;
4. Fasting blood glucose < 6mmol/l (~110mg/dl) and HbA1c <6.5.
Many professional organisations worldwide participated, including the general practitioners/family physicians (WONCA) and the Nurses (ESC Working Group on Cardiovascular Nursing).
Additional comments from the ESC Guidelines team
This new version has been written with increased input from the GPs and cardiovascular nurses and puts more emphasis on exercise, weight and lifestyle. There is more discussion on the limitations of present systems and grading of evidence, redefined priorities and objectives as well as a revised approach to risk in the young. These guidelines also consider total events and mortality and give more detailed information from score on total events, diabetes, HDL cholesterol and body mass index. They also comprise new sections on gender, heart rate, BMI/waist circumference, other manifestations of CVD and renal impairment. Access the European Guidelines on CVD prevention here...
The PDA version of the pocket guidelines will be available soon so keep reading your "My ESC News" newsletters for the announcement of their release.