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European society issues guidelines on cardiovascular disease

BMJ 2003; 327 doi: (Published 04 September 2003) Cite this as: BMJ 2003;327:518
  1. Susan Mayor
  1. London

    New European guidelines extend recommendations for the prevention of coronary heart disease to cardiovascular disease and advise more aggressive interventions in high risk patients to reduce disability and premature deaths.

    Announcing the guidelines at the European Society of Cardiology's annual congress in Vienna, Austria, last week, David Wood, professor of cardiovascular medicine at Imperial College, London, and a member of the guideline development task force, said: “The most important development in the new guidelines is that they cover atherosclerotic cardiovascular disease as a whole rather than focusing just on the prevention of coronary heart disease.”

    He explained that this change recognised that atherosclerotic disease shares similar risk factors and benefits from interventions wherever it is expressed—in the heart, brain, or peripheral vasculature.

    “Recent intervention trials have shown that several forms of therapy prevent not only coronary events and revascularisations but also ischaemic stroke and peripheral artery disease. Therefore, these new guidelines deal with cardiovascular disease prevention, not merely coronary heart disease,” he noted.

    The new guidelines aim to reduce the incidence of first or recurrent clinical events caused by coronary heart disease, ischaemic stroke, and peripheral artery disease (European Heart Journal 2003 ;24: 1601-10).

    The guidelines have introduced a new multifactorial risk model—the SCORE model, based on European data—to improve the accuracy of risk assessment for cardiovascular disease. Previous guidelines calculated coronary heart disease risk on the basis of US data, from Framingham, Massachusetts.

    The new guidelines have also redefined priorities for prevention of cardiovascular disease and tightened the goals for higher risk patients. The first priority for preventive measures remain patients with established cardiovascular disease, including those with cerebrovascular disease and peripheral artery disease, as well as coronary heart disease. The next priority is asymptomatic individuals at high risk of developing coronary heart disease because they have multiple risk factors.

    Patients with type 2 diabetes or with type 1 diabetes with microalbuminuria have been moved up to the high risk group, in recognition that they have multiple risk factors.

    The guidelines have set goals for most patients and for the normal population of <5 mmol/l for total cholesterol level and <3.0 mmol/l for low density lipoprotein (LDL) cholesterol.

    However, for patients with atherosclerotic disease, including those with diabetes, they have tightened targets for total cholesterol (to <4.5mmol/l) and for LDL cholesterol (to < 2.5 mmol/l).

    Blood pressure targets have also been tightened, to less than 130/80 mm Hg for patients with established cardiovascular disease or diabetes.

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