Dr. Perk Joep
In this session, the new prevention guidelines, which have recently been published in several journals, were discussed by four of the contributing chapter coordinators of the document.
G. de Backer (St Martens Latem, BE) showed why CVD prevention is still needed, stating that CVD remains the leading cause of premature death worldwide. It affects both men and women. Of all deaths that occur before the age of 75 years in Europe, 42% are due to CVD in women and 38% in men. He remarked that prevention works: over 50% of the reductions seen in CHD mortality relate to changes in risk factors, and 40% to improved treatments.
I.M. Graham (Dublin, IE) presented an important change in risk stratification as there are now four levels of CVD risk: very high, high, moderate, and low risk. He stated that risk factor screening should be considered in adult men ≥40 years and in women ≥50 years of age or if postmenopausal, even though more European populations are now at lower CVD risk than at the time of the 2007 document. Another novelty was the introduction of the risk-age concept, where using the SCORE charts the absolute 10 year mortality risk of a person can be compared to that of a non-smoking individual with normal levels of blood pressure and total cholesterol. This might give physicians a new tool to convince patients to adopt a heart-healthy lifestyle.
M. Verschuren (Bilthoven, NL) presented the main new elements of the guidelines under the question “how can CVD prevention be used?” These were the importance of avoiding exposure to passive smoking, the role of specific diet patterns where the Mediterranean diet pattern remains the core component of dietary counselling, and the important and effective role of multimodal behavioural intervention in order to assist the patient in changing lifestyle. Due to the limited time for the session, the key messages for the management of blood pressure and blood lipids could not be discussed, but they include that lifestyle measures are needed for all hypertensive patients, all major antihypertensives are equal for clinical use and the target blood pressure is <140/90 mmHg. The recommended LDL-cholesterol levels vary for the different levels of CVD risk.
H. Gohlke (Ballrechten-Dottingen, DE) concluded the session by debating where CVD programmes should be offered. He showed that actions to prevent CVD should be incorporated into everyone’s daily lives, starting in early childhood and continuing throughout adulthood and senescence. The family doctor should be the key person in providing long-term follow-up for CVD prevention and nurse-coordinated prevention programmes should be well integrated into healthcare systems. All patients after an acute ischaemic event should participate in a cardiac prevention and rehabilitation programme to support modifying lifestyle habits and increase treatment adherence. Physicians are encouraged to engage themselves in influencing decision-makers to create legislation for a heart-healthy environment and be heard in the debate on public health. He concluded this informative session by announcing the launch of the pocket version of the guidelines and a one page summary for use in general practice at the occasion of the Munich ESC congress.
The 2012 Guidelines on cardiovascular disease prevention in clinical practice
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