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    European Guidelines On CVD Prevention in Clinical Practice 2016

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    Diego Francisco Garcia Ortiz
    Here are the major new key messages in the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice that are relevant for women: - The guidelines emphasize the need for a population-based approach to cardiovascular disease prevention, as this approach can prevent more cases than focusing only on high-risk individuals. - They recommend governmental restrictions and mandates, media and education campaigns, economic incentives, and interventions in schools, workplaces and communities to promote heart-healthy behaviors like quitting smoking, eating a healthy diet, and increasing physical activity. - The guidelines provide updated risk factor targets for issues like smoking cessation, diet, physical activity, weight management, and blood sugar control for those with diabetes. Meeting these targets can help

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    European Guidelines On CVD Prevention in Clinical Practice 2016

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    Diego Francisco Garcia Ortiz
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    Here are the major new key messages in the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice that are relevant for women: - The guidelines emphasize the need for a population-based approach to cardiovascular disease prevention, as this approach can prevent more cases than focusing only on high-risk individuals. - They recommend governmental restrictions and mandates, media and education campaigns, economic incentives, and interventions in schools, workplaces and communities to promote heart-healthy behaviors like quitting smoking, eating a healthy diet, and increasing physical activity. - The guidelines provide updated risk factor targets for issues like smoking cessation, diet, physical activity, weight management, and blood sugar control for those with diabetes. Meeting these targets can help

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    CVD Prevention

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    Here are the major new key messages in the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice that are relevant for women: - The guidelines emphasize the need for a population-based approach to cardiovascular disease prevention, as this approach can prevent more cases than focusing only on high-risk individuals. - They recommend governmental restrictions and mandates, media and education campaigns, economic incentives, and interventions in schools, workplaces and communities to promote heart-healthy behaviors like quitting smoking, eating a healthy diet, and increasing physical activity. - The guidelines provide updated risk factor targets for issues like smoking cessation, diet, physical activity, weight management, and blood sugar control for those with diabetes. Meeting these targets can help

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    © All Rights Reserved
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    28 views21 pages

    European Guidelines On CVD Prevention in Clinical Practice 2016

    Uploaded by

    Diego Francisco Garcia Ortiz
    Here are the major new key messages in the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice that are relevant for women: - The guidelines emphasize the need for a population-based approach to cardiovascular disease prevention, as this approach can prevent more cases than focusing only on high-risk individuals. - They recommend governmental restrictions and mandates, media and education campaigns, economic incentives, and interventions in schools, workplaces and communities to promote heart-healthy behaviors like quitting smoking, eating a healthy diet, and increasing physical activity. - The guidelines provide updated risk factor targets for issues like smoking cessation, diet, physical activity, weight management, and blood sugar control for those with diabetes. Meeting these targets can help

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    of 21

    EUROPEAN

    GUIDELINES ON CVD
    PREVENTION IN
    CLINICAL PRACTICE
    2016

    Guy De Backer
    Ghent University, Ghent, Belgium
    2

    New 2016 European Guidelines on CVD


    Prevention in Clinical Practice

    G De Backer
    Declaration of interests regarding this
    presentation: review coordinator
    of these guidelines

    www.escardio.org/guidelines
    3

    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).
    ESC Chairperson Co- Chairperson
    Massimo F. Piepoli Arno W. Hoes
    Task Force Members: StefanAgewall(Norway),ChristianAlbus(Germany),CarlosBrotons(Spain),
    AlbericoL.Catapano(Italy),Marie-ThereseCooney(Ireland),UgoCorr(Italy),BernardCosyns(Belgium),
    ChristiDeaton(UK),IanGraham(Ireland),MichaelStephenHall(UK),F.D.RichardHobbs(UK),Maja-LisaLchen
    (Norway),HerbertLllgen(Germany),PedroMarques-Vidal(Switzerland),JoepPerk(Sweden),EvaPrescott
    (Denmark),JosepRedon(Spain),DimitriosJ.Richter(Greece),NaveedSattar(UK),YvoSmulders
    (TheNetherlands),MonicaTiberi(Italy),H.BartvanderWorp(TheNetherlands),InekevanDis(TheNetherlands),
    W.M.MoniqueVerschuren(TheNetherlands)
    Additional Contributor :SimoneBinno(Italy)
    ESC Committee for Practice Guidelines (CPG) and National Cardiac Societies document reviewers: listed in the Appendix.
    ESC entities having participated in the development of this document:
    Associations: EuropeanAssociationforCardiovascularPrevention&Rehabilitation(EACPR),EuropeanAssociationofCardiovascularImaging(EACVI),
    EuropeanAssociationofPercutaneousCardiovascularInterventions(EAPCI),HeartFailureAssociation(HFA).
    Councils: CouncilonCardiovascularNursingandAlliedProfessions,CouncilforCardiologyPractice,CouncilonCardiovascularPrimaryCare.
    Working Groups: CardiovascularPharmacotherapy

    www.escardio.org/guidelines EuropeanHeartJournal2016-doi:10.1093/eurheartj/ehw106
    4

    Guidelines based upon the principles of teaching

    Plato, 424-347 b.C.

    1. What is CVD prevention


    2. Who needs CVD prevention
    3. How is CVD prevention applied
    4. Where should CVD prevention be offered

    www.escardio.org/guidelines
    5

    Population-approach to prevent CVD

    Prevention Paradox : A large number of


    people exposed to a small risk may generate
    many more cases of CVD than a small
    number exposed to a high risk
    Population approach is cost saving and
    efficient:
    A 10% population-wide reduction in blood
    cholesterol, blood pressure and smoking
    would save approximately three times
    more lives than treating 40% of high-risk
    individuals with a statin, three half-dose
    anti-hypertensives and aspirin.
    www.escardio.org/guidelines
    6

    Recommendation for cost-effective prevention of


    cardiovascular disease NEW

    www.escardio.org/guidelines
    7

    Population-approach to prevent CVD NEW

    Levels:
    Topics:
    Governmental restrictions
    Diet
    and mandate
    Physical activity
    Media and education
    Tobacco use
    Labelling and information
    Alcohol abuse
    Economic incentives
    Schools
    Workplaces
    Community Setting

    www.escardio.org/guidelines
    8

    Recommendations for population-based approaches to


    smoking and other tobacco use (1) NEW

    www.escardio.org/guidelines
    9

    SCORE chart:
    chart 10-year risk
    of fatal CVD based on the
    following risk factors: age,
    sex, smoking, systolic
    blood pressure, total
    cholesterol

    www.escardio.org/guidelines
    10

    And what about the other 100+ CV risk factors?

    hs-CRP ?
    Lp(a) ?
    stress ?
    body mass index? waist-hip ratio ?
    intima-media thickness?
    coronary calcium score?

    etcetera

    www.escardio.org/guidelines
    11

    Examples of risk modifiers that


    (1) have risk reclassification potential and (2) are feasible

    www.escardio.org/guidelines
    12

    Risk categories

    Very high-risk Subjectswithanyofthefollowing:


    DocumentedCVD,clinicalorunequivocalonimaging.DocumentedclinicalCVD
    includespreviousAMI,ACS,coronaryrevascularizationandotherarterial
    revascularizationprocedures,strokeandTIA,aorticaneurysmandPAD.
    UnequivocallydocumentedCVDonimagingincludessignificantplaqueon
    coronaryangiographyorcarotidultrasound.ItdoesNOTincludesomeincreasein
    continuousimagingparameterssuchasintimamediathicknessofthecarotid
    artery.
    DMwithtargetorgandamagesuchasproteinuriaorwithamajorriskfactorsuch
    assmokingormarkedhypercholesterolaemiaormarkedhypertension.
    SevereCKD(GFR<30mL/min/1.73m 2).
    AcalculatedSCORE10%.
    High-risk Subjectswith:
    Markedlyelevatedsingleriskfactors,inparticularcholesterol>8mmol/L
    (>310mg/dL)(e.g.infamilialhypercholesterolaemia)orBP180/110mmHg.
    MostotherpeoplewithDM(withtheexceptionofyoungpeoplewithtype1DM
    andwithoutmajorriskfactorsthatmaybeatlowormoderaterisk).
    ModerateCKD(GFR3059mL/min/1.73m2).
    AcalculatedSCORE5%and<10%.
    SCOREis1%and<5%at10years.Manymiddleagedsubjectsbelongtothis
    Moderate-risk
    category.
    Low-risk SCORE<1%.

    www.escardio.org/guidelines
    13

    Risk Factor Targets

    * Smoking: No exposure to tobacco in any form.


    * Diet : Low in saturated fat with a focus on wholegrain
    products, vegetables, fruit and fish.
    Physical activity: At least 150 minutes a week of
    moderate aerobic PA (30 minutes for 5 days/week) or 75
    minutes a week of vigorous aerobic PA (15 minutes for 5
    days/week) or a combination thereof.
    Body weight: BMI 2025 kg/m2.
    Waist circumference:
    <94 cm (men)or <80 cm (women).
    * HbA1c in patients with DM : < 7.0% (< 53 mmol/mol)

    www.escardio.org/guidelines
    14

    Lipids

    LDL-C is the primary target:

    Very high risk: < 1.8 mmol/L (< 70 mg/dL) OR a reduction of at least 50% if the
    baseline LDL-C is between 1.8 and 3.5 mmol/L ( 70 and 135 mg/dL)
    High risk : < 2.6 mmol/L (< 100 mg/dL) OR a reduction of at least 50% if the
    baseline LDL-C is between 2.6 and 5.2 mmol/L ( 100 and 200 mg/dL).
    Low to Moderate risk : < 3.0 mmol/L ( < 115 mg/dL)

    www.escardio.org/guidelines
    15

    Blood pressure targets

    SBP should be lowered to < 140 mmHg (and DBP to <


    90 mmHg) in all treated hypertensive patients < 60
    years old.(I,B)
    In patients > 60 years old with SBP 160 mmHg, the
    treatment goal is to reduce SBP to between 150 and
    140 mmHg.(I,B)
    In fit patients <80 years old, a target SBP < 140 mmHg
    may be considered if treatment is well tolerated. In
    some of these patients a target SBP <120 mmHg may
    be considered when they are at (very) high risk and
    can tolerate multiple antihypertensive drugs.(IIb,B)

    www.escardio.org/guidelines
    16

    Blood pressure targets

    In individuals >80 years and with initial SBP 160


    mmHg, it is recommended to reduce SBP to between
    150 and 140 mmHg provided they are in good physical
    and mental conditions.(I,B)

    In frail elderly patients, it should be considered to be


    careful in terms of treatment intensity (e.g. number of
    antihypertensive drugs) and BP targets, and clinical
    effects of treatment should be carefully
    monitored.(IIa,B)

    www.escardio.org/guidelines
    17

    Major new key messages since 2012. WHO?

    Relevant groups
    In womenriskisdeferredbyapproximately10years
    In persons > 60 yearsofagetheriskthresholds
    shouldbeinterpretedmorelenientlyanduncritical
    initiationofdrugtreatmentsshouldbediscouraged.
    In younger patients,lowabsoluteriskmayimplicatea
    veryhighrelativerisk,anduseoftherelativeriskchart
    mayhelp

    www.escardio.org/guidelines
    18

    2016 European Guidelines on CVD Prevention in


    Clinical Practice Web addenda

    Web Contents
    How to intervene at the individual level:
    Atrial fibrillation
    Coronary artery disease
    Chronic heart failure
    Cerebrovascular disease
    Peripheral artery disease
    Web Figures
    Web Tables
    Web References

    www.escardio.org/guidelines
    19

    2016 European Guidelines on CVD Prevention in


    Clinical Practice

    To do and not to do messages:


    Recommendations for:
    - cardiovascular risk assessment
    - how to estimate CV risk
    - how to intervene
    - achieving medication and healthy lifestyle
    adherence
    - CVD prevention implementation

    www.escardio.org/guidelines
    EUROPEAN CVD PREVENTION IN CLINICAL PRACTICE
    (2016)

    The Pocket Guidelines


    are available at the
    registration area from
    Sunday 28 August
    afternoon

    www.escardio.org/guidelines
    21

    2016 European Guidelines on CVD Prevention in


    Clinical Practice

    Thank You for


    Your
    Attention

    www.escardio.org/guidelines

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