• Cardiology Guidelines
• Prevention & Screening

Joep Perk, MD, Linnéuniversitetet, Kalmar, Sweden, presented a short summary with the main recommendations of the 2012 European Guidelines on cardiovascular disease (CVD) prevention in clinical practice. The Fifth Joint Task Force of the European Society of Cardiology and other societies on CVD prevention included representatives of 9 societies and invited experts [Perk J et al. Atherosclerosis 2012; Eur Heart J 2012].

According to Prof. Perk, the 2012 version is practical, shorter, and more adapted to clinical needs. It addresses 5 questions: 1) What is CVD prevention? 2) Why is it needed? 3) Who needs it? 4) How is it applied? and 5) Where should it be offered?

CVD prevention is needed because atherosclerotic CVD remains the leading cause of premature death worldwide. CVD 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. Prevention works. Over 50% of the reductions seen in CHD mortality relate to changes in risk factors and 40% to improved treatments [J Perk et al. Eur Heart J 2012].

One way this year's guidelines differ from earlier years is how recommendations are graded (strong or weak). Prior recommendations were based on graded evidence, giving randomized, controlled trials the greatest weight while undervaluing population studies, said Prof. Perk.

Risk age is a new way to drive home the importance of prevention to patients. For example, a 40-year-old male smoker with the same risk factors as a 60-year-old man with ideal risk factor levels has a risk age of 60 years.

Total risk estimation using multiple risk factors (eg, the Systematic Coronary Risk Evaluation Project [SCORE]) is recommended for all asymptomatic adults. Those at high risk can be identified by the presence of established CVD, type 1 or type 2 diabetes with end-organ damage, moderate to severe renal disease, or very high levels of individual risk factors (eg, a high SCORE risk; Table 1).

Major recommendations cover smoking, nutrition, physical activity, blood pressure, diabetes mellitus (Table 2), dyslipidemia (risk defined by low-density lipoprotein cholesterol level) with and without severe chronic kidney disease, patient adherence, and where and when CVD prevention programs should be offered.

Four key messages were emphaized:

• Risk-factor screening, including lipid profile, should be performed in adult men ≥40 years of age and women ≥50 years or postmenopausal.

• The physician in general practice is the key person to initiate, coordinate, and provide long-term follow-up for CVD prevention.

• The practicing cardiologist should be the advisor in cases where there is uncertainty over the use of preventive medication or when usual preventive options are difficult to apply.

• Patients with cardiac disease may participate in self-help programs to increase or maintain awareness of the need for risk factor management.

Prof. Perk also pointed out that nongovernmental organizations are important to healthcare workers in promoting preventive cardiology and the European Heart Health Charter marks the start of a new era of political engagement in preventive cardiology.

• © 2012 MD Conference Express®