2016 European Guidelines on cardiovascular disease prevention in clinical practice

Piepoli, Massimo F; Hoes, Arno W.; Agewall, Stefan; Albus, Christian; Brotons, Carlos; Catapano, Alberico L.; Cooney, Marie Therese; Corrà, Ugo; Cosyns, Bernard; Deaton, Christi; Graham, Ian; Hall, Michael Stephen; Hobbs, FD Richard; Løchen, Maja‐Lisa; Löllgen, Herbert; Marques‐Vidal, Pedro; Perk, Joep; Prescott, Eva; Redón, Josep; Richter, Dimitrios J; Sattar, Naveed; Smulders, Yvo M.; Tiberi, Monica; Worp, H. Bart van der; Dis, Ineke van; Verschuren, W M Monique; Binno, Additional Contributor: Simone; Backer, Guy De; Roffi, Marco; Aboyans, Victor; Bachl, Norbert; Bueno, Héctor; Carerj, Scipione; Cho, Leslie; Cox, J. Thomas; Sutter, Johan De; Egidi, Günther; Fisher, Miles; Fitzsimons, Donna; Franco, Oscar H.; Guenoun, Maxime; Jennings, Catriona; Jug, Borut; Kirchhof, Paulus; Kotseva, Kornelia; Lip, Gregory Y.H.; Mach, François; Mancia, Giuseppe; Bermudo, Franz Martin; Mezzani, Alessandro; Niessner, Alexander; Ponikowski, Piotr; Rauch, Bernhard; Rydén, Lars; Stauder, Adrienne; Turc, Guillaume; Wiklund, Olov; Windecker, Stephan; Zamorano, José Luís

doi:10.1177/2047487316653709

Cited by 677 publications

(189 citation statements)

References 571 publications

(577 reference statements)

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“…It is a dilemma that the successful activities of the past century to improve access to high‐caloric and low‐priced food to overcome undernutrition, on the one hand, and offer motorized transport to almost everywhere, including elevators and escalators, to allow all individuals to participate in social life, despite physical limitations or disabilities, on the other hand, promote a sedentary lifestyle and obesity. Thus, it is recommended to start physical activity education early in childhood 113. A randomized trial of daily exercise lessons at school compared with regular school sports twice weekly was shown to improve cardiovascular fitness and prevent obesity and supports the recommendation of regular classroom physical activity and exercise lessons 123.…”

Section: Perspectivesmentioning

confidence: 72%

“…International guidelines, such as the European guidelines on cardiovascular disease prevention in clinical practice (published in 2016), clearly recommend regular exercise training as a cornerstone of CAD prevention and treatment 113. In general, >150 minutes of endurance exercise training per week at moderate to vigorous intensity, with a total energy expenditure of 1000 to 2000 kcal or >75 minutes at vigorous intensity, ideally spread over 3 to 5 days, is recommended.…”

Section: Exercise Prescriptionmentioning

confidence: 99%

“…Exercise training should be started at a low(er) intensity and gradually increased over time. Endurance exercise should be complemented by resistance exercise training 2 times per week at moderate intensity 113. With evidence in mind that cardiorespiratory fitness is a better predictor of mortality than physical activity, it was thought that a certain amount of exercise is necessary to increase fitness and thereby achieve any beneficial health effect, with exercise intensity having higher importance than duration 23, 24.…”

Section: Exercise Prescriptionmentioning

confidence: 99%

See 2 more Smart Citations

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Winzer

Woitek

Linke

2018

JAHA

158

110

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Section: Perspectivesmentioning

confidence: 72%

Section: Exercise Prescriptionmentioning

confidence: 99%

Section: Exercise Prescriptionmentioning

confidence: 99%

See 1 more Smart Citation

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Winzer

Woitek

Linke

2018

JAHA

158

110

View full text Add to dashboard Cite

“…The European Guidelines on CVD prevention suggest that imaging methods for atherosclerotic burden are relevant, especially in individuals at intermediate risk based on TRFs, to improve cardiovascular risk stratification and preventive strategy 38, 39. Methodological issues about measurement of carotid IMT on the individual level have been raised, and in the most recent guidelines,40, 41 IMT screening is not recommended. On the other hand, carotid artery plaque assessment, including thickness and TPA, has been proposed as risk modifiers in CVD risk prediction, but formal reclassification analyses have not yet been fully evaluated 40.…”

Section: Discussionmentioning

confidence: 99%

“…Methodological issues about measurement of carotid IMT on the individual level have been raised, and in the most recent guidelines,40, 41 IMT screening is not recommended. On the other hand, carotid artery plaque assessment, including thickness and TPA, has been proposed as risk modifiers in CVD risk prediction, but formal reclassification analyses have not yet been fully evaluated 40. NRI added by plaque measures in CVD risk prediction has previously been reported by the ARIC (Atherosclerosis Risk in Communities) Study and Three City Study, with overall categorical NRI ranging from 7.7% to 13.1% 42, 43.…”

Section: Discussionmentioning

confidence: 99%

Joint Effect of Carotid Plaque and C‐Reactive Protein on First‐Ever Ischemic Stroke and Myocardial Infarction?

Eltoft

Arntzen

Wilsgaard

et al. 2018

JAHA

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BackgroundThe joint effect of atherosclerosis and CRP (C‐reactive protein) on risk of ischemic stroke (IS) and myocardial infarction (MI) has been sparsely studied. The aim of this study was to explore whether CRP mediates the risk of events in subjects with prevalent carotid plaque, examine synergism, and test whether CRP and carotid plaque add to risk prediction beyond traditional risk factors.Methods and Results CRP and carotid total plaque area (TPA) were measured in 10 109 participants in the Tromsø Study from 1994 to 2008. Incident IS (n=671) and MI (n=1079) were registered until December 31, 2013. We calculated hazard ratios (HRs) of MI and IS according to categories of CRP (<1, 1–3, and >3 mg/L) and plaque status (no plaque and TPA below and above median) in Cox proportional hazard models with time‐varying covariates. Multivariable‐adjusted CRP >3 versus <1 mg/L was associated with risk of IS (HR, 1.84; 95% confidence interval, 1.49–2.26) and MI (HR, 1.46; 95% confidence interval, 1.23–1.73). TPA above median versus no plaque was associated with risk for IS (HR, 1.65; 95% confidence interval, 1.36–2.01) and MI (HR, 1.64; 95% confidence interval, 1.41–1.92). In participants with plaque, adjustment for CRP minimally attenuated the risk estimates. The highest incidence rates for MI and IS were seen in the group with both CRP >3 mg/L and TPA is above the median. TPA and CRP combined added to risk prediction beyond traditional risk factors.ConclusionsThe simultaneous presence of subclinical atherosclerosis and elevated CRP was associated with increased risk of IS and MI. The combined assessment of subclinical atherosclerosis and inflammatory biomarkers may improve cardiovascular disease risk stratification.

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A Still-Ignored Cardiovascular Risk Factor—A History of Preeclampsia

Sciatti

Orabona

2021

JAMA Cardiol

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In Reply First, the purpose of our study 1 was explicitly described as assessing the implications of lipoprotein(a) screening in the context of primary prevention for atherosclerotic cardiovascular disease, with a particular emphasis on individuals not already being treated with statin therapy. Elevated lipoprotein(a) levels for primary prevention includes lifestyle counseling and statin therapy; thus, including individuals already treated with statin therapy may not be informative. 2,3 However, we do agree that, as described in the Limitations section, 1 the UK Biobank cohort has a healthy volunteer bias and is predominately composed of individuals of European ancestry, which may limit the generalizability of some of our results.Second, we do not agree that our statement that extreme lipoprotein(a) levels greater than 200 mg/dL (approximately 500 nmol/L) could have a 3-fold to 4-fold increased risk of atherosclerotic cardiovascular disease is unqualified. Schrock is correct to point out that lipoprotein(a) levels are a continuous variable and display associations with increased risk of atherosclerotic cardiovascular disease at lower levels. Our results, which describe the association between a 120-nmol/L (approximately 50-mg/dL) increase in observed and genetically predicted lipoprotein(a) levels, specifically address this issue. 1 This statement was intentionally made to suggest that, similar to familial hypercholesterolemia, extremely elevated lipoprotein(a) levels can be associated with very high risk of atherosclerotic risk disease but only modestly improve disease discrimination because of its rarity. Accordingly, we state that "efficient strategies to identify individuals with extremely elevated lipoprotein(a) levels require further research." 1 It is also important to note that the cholesterol component of lipoprotein(a) contributes to the total cholesterol measurements used to calculate cardiovascular risk scores using QRISK3 and Pooled Cohort Equations. 4 Thus, these cardiovascular risk scores may underestimate the cardiovascular risk associated with elevated lipoprotein(a) levels when observed or genetically predicted lipoprotein(a) is added to the discrimination models.Third, we agree that identification of elevated lipoprotein(a) levels in an individual patient is indeed helpful for cardiovascular risk assessment. In the Discussion section, 1 we explicitly state approaches such as cascade screening are helpful for identifying families with elevated lipoprotein(a) levels. However, the question that the article sought to address was whether screening for elevated lipoprotein(a) levels in the context of primary prevention for individuals with intermediate cardiovascular risk is useful on a population level, rather than in the context of an individual patient with symptomatic cardiovascular disease. Finally, it is important to mention that the interpretation of these results may change if prospectively demonstrated effective therapies to lower lipoprotein(a) levels become available in the future. 5,6 ...

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2016 European Guidelines on cardiovascular disease prevention in clinical practice

Cited by 677 publications

References 571 publications

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Joint Effect of Carotid Plaque and C‐Reactive Protein on First‐Ever Ischemic Stroke and Myocardial Infarction?

A Still-Ignored Cardiovascular Risk Factor—A History of Preeclampsia

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