Secondary prevention of atherosclerotic cardiovascular disease
Summary
In patients with established atherosclerotic cardiovascular disease (ASCVD) prevention of recurrent events remains a significant challenge. After a clinical event or after elective revascularization procedures, secondary prevention strategies are preferably implemented as part of a cardiac rehabilitation program that should be offered to all patients to improve quality of life and to reduce cardiovascular morbidity and mortality. In case of stable and uncomplicated ASCVD this should include adaptations of lifestyles related to smoking of tobacco, nutrition and exercise, control of arterial hypertension, dyslipidaemias and diabetes and the use of cardioprotective drugs. Randomized prospective clinical trials firmly established the effectiveness and safety of these preventive interventions, and the obtained scientific evidence resulted in strong recommendations in guidelines on cardiovascular disease prevention.
Unfortunately, results from registries and surveys show that implementing these guidelines on secondary prevention of ASCVD is far from optimal with a high prevalence of persistent smoking, sedentary lifestyle, uncontrolled hypertension and dyslipidaemias and an increasing prevalence of obesity, central obesity and diabetes. Despite the widespread use of drugs, the management of risk factors does not meet therapeutic targets in far too many patients. All this calls for a multidisciplinary approach to raise the standard of secondary prevention in...
Sign up for free!
Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com
- Piepoli MF, Corra U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction A call for action. Eur J Prev Cardiol. 2016 23 1994 2006.
- Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Lochen ML, Lollgen H, Marques Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM. 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. Eur Heart J. 2016 37 2315 2381.
- Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman J, De Backer G, Delgado V, Ference BA, Graham I, Halliday A, Landmesser U, Mihaylova B, Pedersen T, Riccardi G, Richter D, Sabatine M, Taskinen MJ, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias Lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 41 111 88.
- Williams B, Mancia G, Spiering W, Agabiti E, Azizi RM,Burnier M Clement DL, Coca A, de Simone, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. ESC Scientific Document Group 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 39 3021–3104.
- Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Juni P, Lettino M, Marx N, Mellbin LG, Ostgren CJ, Rocca B, Roffi M, Sattar N, Sefervic PM, Sousa Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre diabetes and cardiovascular disease. Eur Heart J. 2019.
- van Halewijn G, Deckers J, Tay HY, van Domburg R, Kotseva K, Wood D. Lessons from contemporary trials of cardiovascular prevention and rehabilitation A systematic review and meta analysis. Int J Cardiol. 2017 232 294 303.
- Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021 42 17 96.
- Kotseva K, De Backer G, De Bacquer D, Ryden L, Hoes A, Grobbee D, Maggioni A, Marques Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stoerk S, Tokgozoğlu L, Tsioufis C, Vulic D, Wood D on behalf of the EUROASPIRE Investigators. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries Results from the European Society of Cardiology EUROASPIRE V survey. Eur J Prev Cardiol. 2019 26 824 835.
- Gyberg V, De Bacquer D, Kotseva K, De Backer G, Schnell O, Sundvall J, Tuomilehto J, Wood D, Ryden L, EUROASPIRE IV Investigators. Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c a report from EUROASPIRE IV a survey from the European Society of Cardiology. Eur Heart J. 2015 36 1171–1177.
- Neumann FJ, Sousa Uva M, Ahlsson A, Alfonso, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PA, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. ESC Scientific Document Group 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 40 87 165.
- Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST segment elevation of the European Society of Cardiology ESC. Eur Heart J. 2018 39, 119 177.