Cardiovascular disease prevention in clinical practice - Guidelines ESC 2012

1.1 Introduction

Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has fallen considerably over recent decades in many European countries. It is estimated that .80% of all CVD mortality now occurs in developing countries.

CVD causes mass disability: within the coming decades the disability-adjusted life years (DALYs) estimate is expected to rise from a loss of 85 million DALYs in 1990 to a loss of 150 million DALYs globally in 2020, thereby remaining the leading somatic cause of loss of productivity.1

CVD is strongly connected to lifestyle, especially the use of tobacco, unhealthy diet habits, physical inactivity, and psychosocial stress.2 The World Health Organization (WHO) has stated that over three-quarters of all CVD mortality may be prevented with adequate changes in lifestyle. CVD prevention, remaining a major challenge for the general population, politicians, and healthcare workers alike, is defined as a co-ordinated set of actions, at public and individual level, aimed at eradicating, eliminating, or minimizing the impact of CVDs and their related disability. The bases of prevention are rooted in cardiovascular epidemiology and evidence-based medicine.3

The aim of the 2012 guidelines from the Fifth Joint Task Force (JTF) of the European Societies on Cardiovascular Disease Prevention in Clinical Practice is to give an update of the present knowledge in preventive cardiology for physicians and other health workers. The document differs from 2007 guidelines in several ways: there is a greater focus on new scientific knowledge. The use of grading systems [European Society of Cardiology (ESC) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)] allows more evidence-based recommendations to be adapted to the needs of clinical practice.

The reader will find answers to the key questions of CVD prevention in the five sections: what is CVD prevention, why is it needed, who should benefit from it, how can CVD prevention be applied, and when is the right moment to act, and finally where prevention programmes should be provided.

A literature search of clinical guidelines aimed at cardiovascular risk assessment in clinical practice identified .1900 publications.4

When these were evaluated using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument, only seven achieved the level considered ‘considerable rigour’. Too much guidance and too little impact? The gap between state-of-the-art knowledge and its implementation in clinical practice remains wide, as shown in recent surveys such as EUROASPIRE III.5 Family doctors may be flooded with recommendations in the wide field of family medicine.

Finding time to read and implement the many guidelines can be an overwhelming task in a busy primary care centre or a regional hospital clinic.

The Task Force behind the 2012 recommendations has chosen to limit the size to the level of the executive summary of previous JTF publications. All relevant reference material is available on the dedicated CVD Prevention Guidelines page of the ESC Website (www.escardio.org/guidelines). A one-page summary of all strong recommendations according to the GRADE system will be provided, which may stimulate implementation; and a pocket version will be available for daily clinical use.

© The European Society of Cardiology and the European Respiratory Society 2012. All rights reserved.