Global preventive policies. Strategies at European and worldwide level

Cardiovascular diseases (CVD), of which coronary heart disease is the most common, are the major causes of death in middle-aged and older patients in most developed countries and in many developing countries. The comprehensive action for CVD prevention has to include: a) "population" strategy--for altering the lifestyle and environmental factors in the entire population, and b) "high-risk" strategy--identification of people at high cardiovascular risk. The principles for CVD prevention were described by several International Heart Health Conferences: Victoria Declaration (1992), Catalonia Declaration (1996), Singapore Declaration (1998), Osaka Declaration (2001), International Principles for National and Regional Guidelines on CVD Prevention (2004), Luxemburg Declaration (2005), and European Heart Health Charter (2006). There is an international consensus among guidelines regarding the priorities and goals for CVD prevention, lifestyles and risk factor management, and use of cardioprotective medication. Patients with established CVD are considered to be a top priority for prevention. For healthy individuals, the decision to treat blood pressure or lipids depends on the level of absolute multifactorial risk for developing CVD. The risk charts and tables can be used to decide the likelihood of cardiovascular events and the intensity of risk factor management. The guidelines provide guidance to policy-makers and health care workers on how to target high risk people in different resource settings, using evidence-based and cost-effective preventive approaches.