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The treatment potential in preventive cardiology
1National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse Street, London, SW3 6LY, UK. d.wood@ic.ac.uk
Insights
European guidelines recommend preventing coronary heart disease (CHD) by focusing on lifestyle changes and medication for high-risk patients. Further risk reduction is possible by improving adherence to these prevention strategies.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Established guidelines exist for preventing coronary heart disease (CHD).
- Patients with existing CHD or atherosclerotic disease are at high risk for further events.
- Current clinical practice shows many patients do not meet recommended lifestyle and risk factor goals.
Purpose of the Study:
- To outline the 1998 Joint European Societies' recommendations for CHD prevention in clinical practice.
- To identify priorities for CHD prevention, focusing on high-risk individuals.
- To highlight the potential for improved preventive care through lifestyle and pharmacotherapy.
Main Methods:
- Review of the 1998 Joint European Societies' recommendations.
- Analysis of clinical practice surveys (e.g., EUROASPIRE) to assess goal achievement.
- Identification of key lifestyle and risk factor targets for CHD prevention.
Main Results:
- Top priority: patients with established CHD or atherosclerotic disease.
- Lifestyle goals: smoking cessation, healthy diet, physical activity.
- Risk factor goals: Blood Pressure < 140/90 mmHg, Total Cholesterol < 5.0 mmol/l, LDL-Cholesterol < 3.0 mmol/l.
- Recommended drug therapies: aspirin, beta-blockers, ACE inhibitors, lipid modification, anticoagulants.
- Screening of relatives of patients with premature CHD.
Conclusions:
- Significant potential exists to reduce CHD risk in established cases.
- Improved adherence to lifestyle modifications and pharmacotherapy can enhance preventive care.
- Effective implementation leads to longer life and better quality for patients.
Abstract:
The Joint European Societies--European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension--1998 recommendations on prevention of coronary heart disease (CHD) in clinical practice set priorities and goals. The top priority is patients with established CHD, or other atherosclerotic disease, because they are already under the care of cardiologists and are at high risk of further morbidity and mortality. The lifestyle goals are to stop smoking, make healthy food choices and be active physically. The risk factor goals are a BP < 140/90 mmHg, total cholesterol < 5.0 mmol/l (190 mg/dl) and LDL-cholesterol < 3.0 mmol/l (115 mg/dl). The appropriate use of prophylactic drug therapies--aspirin, beta-blockers, ACE inhibitors, lipid modification therapies and anticoagulants--is also a recommended goal. The final goal is to screen relatives of patients with premature CHD (men < 55 years and women < 65 years). Surveys of clinical practice such as EUROASPIRE (European Action on Secondary Prevention) have shown risk can be further reduced in patients with established CHD because many are not achieving these lifestyle and risk factor goals. So there is considerable potential to raise the standard of preventive care for coronary patients through more effective lifestyle intervention and the use of drug therapies with proven efficacy. For the patient, this will mean a longer life with better quality.
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