The new ESC guidelines for the prevention of cardiovascular diseases – what changes do they bring to medical practice? Review article
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Published:
Mar 31, 2022
Keywords:
guidelines, cardiovascular diseases, hypertension, hyperlipidemia, diabetes, non-HDL, SCORE2
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Abstract
The ESC 2021 cardiovascular disease prevention guidelines emphasize the individualization of therapy based on the age, risk factors, comorbidities. New SCORE2 tables have been developed (for younger and older people), which include non-HDL-C levels instead of total cholesterol. A novelty is the introduction of a two-stage scheme of achieving therapeutic goals, which should accelerate decision-making and optimize antihypertensive- lipid-lowering treatment. New recommendations for prophylaxis, imaging tests and pharmacotherapy have also been introduced.
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How to Cite
Broncel , M. (2022). The new ESC guidelines for the prevention of cardiovascular diseases – what changes do they bring to medical practice?. Medycyna Faktow (J EBM), 15(1(54), 8-17. https://doi.org/10.24292/01.MF.0122.1
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References
1. Visseren FLJ, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42: 3227-337.
2. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37: 2315-81.
3. SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021; 42: 2439-54.
4. World Health Organization. Disease burden and mortality estimates. www.who.int/healthinfo/global_burden_disease/estimates/en (access: 4.06.2021).
5. Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017; 357: j2099.
6. Boekholdt SM, Arsenault BJ, Mora S et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA. 2012; 307: 1302-9.
7. Lin JS, Evans CV, Johnson E et al. Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018; 320: 281-97.
8. Peters SA, den Ruijter HM, Bots ML et al. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012; 98: 177-84.
9. Hadamitzky M, Freissmuth B, Meyer T et al. Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging. 2009; 2: 404-11.
10. SCOT-HEART Investigators; Newby DE, Adamson PD, Berry C et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018; 379: 924-33.
11. Peters SA, den Ruijter HM, Bots ML et al. Improvements in risk stratificat ion for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012; 98: 177-84.
12. Tzoulaki I, Siontis KC, Evangelou E et al. Bias in associations of emerging biomarkers with cardiovascular disease. JAMA Intern Med. 2013; 173: 664-71.
13. McDermott MM, Greenland P, Liu K et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002; 136: 873-83.
14. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300: 197-208.
15. Lelieveld J, Pozzer A, Poschl U et al. Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective. Cardiovasc Res. 2020; 116: 1910-7.
16. Mahmoud AN, Mentias A, Elgendy AY et al. Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open. 2018; 8: e020498.
17. Sacco S, Ornello R, Ripa P et al. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol. 2015; 22: 1001-11.
18. DeLay KJ, Haney N, Hellstrom WJ. Modifying Risk Factors in the Management of Erectile Dysfunction: A Review. World J Mens Health. 2016; 34: 89-100.
19. Fan Y, Hu B, Man C et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol. 2018; 36: 1681-9.
20. Skjaerven R, Wilcox AJ, Klungsoyr K et al. Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study. BMJ. 2012; 345: e7677.
21. Lykke JA, Paidas MJ, Damm P et al. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG. 2010; 117: 274-81.
22. Agca R, Heslinga SC, Rollefstad S et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017; 76: 17-28.
23. Beckman JA, Duncan MS, Alcorn CW et al. Association of Human Immunodeficiency Virus Infection and Risk of Peripheral Artery Disease. Circulation. 2018; 138: 255-65.
24. Smeeth L, Thomas SL, Hall AJ et al. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004; 351: 2611-8.
25. Hu Y, Zong G, Liu G et al. Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality. N Engl J Med. 2018; 379: 623-32.
26. Hartmann-Boyce J, Chepkin SC, Ye W et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018; 5: CD000146.
27. Sofi F, Abbate R, Gensini GF et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92: 1189-96.
28. Cardoso L, Rodrigues D, Gomes L et al. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes Metab. 2017; 19: 1222-32.
29. Ridker PM, Everett BM, Thuren T et al; CANTOS Trial Group. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017; 377: 1119-31.
30. Mam V, Hasan A, Rosenberg Y et al; CIRT Investigators. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med. 2019; 380: 752-62.
31. Tardif JC, Kouz S, Waters DD et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019; 381: 2497-505.
32. Nidorf SM, Fiolet ATL, Mosterd A et al. LoDoCo2 Trial Investigators. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020; 383: 1838-47.
33. Tykarski A, Filipiak KJ, Januszewicz A et al. Zasady postępowania w nadciśnieniu tętniczym – 2019 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce. 2019; 5: 1-84.
34. Niklas A, Marcinkowska J, Kozela M et al. Blood pressure and cholesterol control in patients with hypertension and hypercholesterolemia: the results from the Polish multicenter national health survey WOBASZ II. Pol Arch Intern Med. 2019; 129: 864-73.
35. Simon A, Dezsi CA. Treatment of hypertensive and hypercholesterolaemic patients with the triple fixed combination of atorvastatin, perindopril and amlodipine: The results of the CORAL Study. Adv Ther. 2019; 36: 2010-20.
36. Sever P, Dahlöf B, Poulter N et al. ASCOT Steering Committee Members. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J. 2006; 27: 2982-8.
2. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37: 2315-81.
3. SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. 2021; 42: 2439-54.
4. World Health Organization. Disease burden and mortality estimates. www.who.int/healthinfo/global_burden_disease/estimates/en (access: 4.06.2021).
5. Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017; 357: j2099.
6. Boekholdt SM, Arsenault BJ, Mora S et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA. 2012; 307: 1302-9.
7. Lin JS, Evans CV, Johnson E et al. Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018; 320: 281-97.
8. Peters SA, den Ruijter HM, Bots ML et al. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012; 98: 177-84.
9. Hadamitzky M, Freissmuth B, Meyer T et al. Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging. 2009; 2: 404-11.
10. SCOT-HEART Investigators; Newby DE, Adamson PD, Berry C et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018; 379: 924-33.
11. Peters SA, den Ruijter HM, Bots ML et al. Improvements in risk stratificat ion for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012; 98: 177-84.
12. Tzoulaki I, Siontis KC, Evangelou E et al. Bias in associations of emerging biomarkers with cardiovascular disease. JAMA Intern Med. 2013; 173: 664-71.
13. McDermott MM, Greenland P, Liu K et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002; 136: 873-83.
14. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300: 197-208.
15. Lelieveld J, Pozzer A, Poschl U et al. Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective. Cardiovasc Res. 2020; 116: 1910-7.
16. Mahmoud AN, Mentias A, Elgendy AY et al. Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open. 2018; 8: e020498.
17. Sacco S, Ornello R, Ripa P et al. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol. 2015; 22: 1001-11.
18. DeLay KJ, Haney N, Hellstrom WJ. Modifying Risk Factors in the Management of Erectile Dysfunction: A Review. World J Mens Health. 2016; 34: 89-100.
19. Fan Y, Hu B, Man C et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol. 2018; 36: 1681-9.
20. Skjaerven R, Wilcox AJ, Klungsoyr K et al. Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study. BMJ. 2012; 345: e7677.
21. Lykke JA, Paidas MJ, Damm P et al. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG. 2010; 117: 274-81.
22. Agca R, Heslinga SC, Rollefstad S et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017; 76: 17-28.
23. Beckman JA, Duncan MS, Alcorn CW et al. Association of Human Immunodeficiency Virus Infection and Risk of Peripheral Artery Disease. Circulation. 2018; 138: 255-65.
24. Smeeth L, Thomas SL, Hall AJ et al. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004; 351: 2611-8.
25. Hu Y, Zong G, Liu G et al. Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality. N Engl J Med. 2018; 379: 623-32.
26. Hartmann-Boyce J, Chepkin SC, Ye W et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018; 5: CD000146.
27. Sofi F, Abbate R, Gensini GF et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92: 1189-96.
28. Cardoso L, Rodrigues D, Gomes L et al. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes Metab. 2017; 19: 1222-32.
29. Ridker PM, Everett BM, Thuren T et al; CANTOS Trial Group. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017; 377: 1119-31.
30. Mam V, Hasan A, Rosenberg Y et al; CIRT Investigators. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med. 2019; 380: 752-62.
31. Tardif JC, Kouz S, Waters DD et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019; 381: 2497-505.
32. Nidorf SM, Fiolet ATL, Mosterd A et al. LoDoCo2 Trial Investigators. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020; 383: 1838-47.
33. Tykarski A, Filipiak KJ, Januszewicz A et al. Zasady postępowania w nadciśnieniu tętniczym – 2019 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce. 2019; 5: 1-84.
34. Niklas A, Marcinkowska J, Kozela M et al. Blood pressure and cholesterol control in patients with hypertension and hypercholesterolemia: the results from the Polish multicenter national health survey WOBASZ II. Pol Arch Intern Med. 2019; 129: 864-73.
35. Simon A, Dezsi CA. Treatment of hypertensive and hypercholesterolaemic patients with the triple fixed combination of atorvastatin, perindopril and amlodipine: The results of the CORAL Study. Adv Ther. 2019; 36: 2010-20.
36. Sever P, Dahlöf B, Poulter N et al. ASCOT Steering Committee Members. Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial. Eur Heart J. 2006; 27: 2982-8.