Cardiovascular disease prevention, Symposium, 726006.
Vienna, Austria, 2 September 2007:
The new (Fourth) Joint European Society's Guidelines on Cardiovascular Disease Prevention in clinical practice were launched at the ESC Annual Conference today.
Chairperson of the Joint Task Force, Professor Ian Graham, said that the guidelines are unique in that they represent a partnership between nine major players in cardiovascular prevention: The European Society of Cardiology and its association for Cardiovascular Prevention and Rehabilitation; the European Atherosclerosis Society; the European Society of Hypertension, the European Society of General Practice / Family Medicine; the European Heart Network; the European Association for the Study of Diabetes, the International Diabetes Federation of Europe; the International Society of Behavioural Medicine and the European Stroke Initiative. This partnership demanded a vigorous and detailed process of internal and external reviews and approvals.
A strength of the new guidelines is it continues to stress that the hardening of the arteries that causes heart attacks and strokes is, in most people, the result of multiple risk factors. This makes the estimation of total risk of critical importance. For example, a sixty year old woman with a cholesterol of 8 may have a risk that is 10 times lower than a 60 year old man with a cholesterol of 5 if the latter is a smoker with high blood pressure.
The guidelines are new in several respects:
1. In order to improve the practical utility of the guidelines, there has been increased input from general practice and from cardiovascular nursing.
2. The emphasis on exercise, weight and lifestyle changes has been increased.
3. There is a detailed discussion on the limitations of present systems of grading evidence.
4. Priorities and objectives have been redefined.
5. The approach to risk in younger persons has been revised with the introduction of a new chart showing relative risks - even though absolute risk is low in young people, they may be at twelve times higher risk than they need to be if they are hypertensive, hyperlipideamic and a smoker.
6. There is more information on the prediction of total as well as fatal events, cardiovascular events, and on the impact of diabetes, low HDL, ‘good’ cholesterol and body mass index on risk.
7. New sections have been added on gender, heart rate, body mass index and waist circumference, other manifestations of cardiovascular disease and renal impairment.
The characteristics of people who are likely to stay healthy are summarised as: 0 3 5 140 5 3 0
0 = no tobacco
3 = walk 3 kilometres daily, or undertake 30 minutes of moderate activity.
5 = portions of fruit and vegetables a day.
140 = blood pressure less than 140 systolic.
5 = total cholesterol less than 5 mmols per litre.
3 = LDL cholesterol less than 3 mmols per litre.
0 = avoidance of overweight and diabetes.
While these are reasonable objectives for healthy people, more intense objectives are recommended for high risk persons. These include, if feasible, a blood pressure of 130/80, total cholesterol of under 4.5 mmls per litre with an option of under 4 mmls per litre if feasible, an LDL cholesterol of under 2.5 mmls per litre with an option of under 2 mmls per litre if feasible, and a fasting blood glucose of less than 6 mmls per litre and a HbA1c of under 6.5% if feasible.
These new guidelines are entirely compatible with the new European Heart Health Charter. The Charter advocates the development and implementation of comprehensive health strategies, measures and policies at European, National, Regional and Local level that promote cardiovascular health and the prevention of cardiovascular disease. They reflect the consensus arising from a multi-disciplinary partnership between the major European professional bodies represented.