2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)

Visseren, Frank L J; Mach, François; Smulders, Yvo M.; Carballo, David; Koskinas, Konstantinos C.; Bäck, Maria; Bénétos, Athanase; Biffi, Alessandro; Boavida, José-Manuel; Capodanno, Davide; Cosyns, Bernard; Crawford, C. Merle; Davos, Constantinos H.; Desormais, Iléana; Angelantonio, Emanuele Di; Franco, Oscar H.; Halvorsen, Sigrun; Hobbs, F.D. Richard; Hollander, Monika; Jankowska, Ewa A.; Michal, Matthias; Sacco, Simona; Sattar, Naveed; Tokgözoğlu, Lâle; Tonstad, Serena; Tsioufis, Κonstantinos; Dis, Ineke van; Gelder, Isabelle C. Van; Wanner, Christoph; Williams, Bryan

doi:10.1016/j.rec.2022.04.003

Cited by 325 publications

(618 citation statements)

References 506 publications

Supporting

Mentioning

520

Contrasting

Unclassified

Order By: Relevance

“…Also, we could not conclude on the long-term effects of the training beyond four months. Finally, our study was conducted in a very high cardiovascular risk population ( 20 ). These findings are generalizable to currently underrepresented populations with similar healthcare systems and EMS staffing patterns, including but not limited to Baltic states and Eastern European countries.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the duration of the training effects remains unknown ( 19 ). Finally, the paucity of studies in very high cardiovascular risk populations, such as the Baltic countries, urged us to investigate prehospital stroke care intervention in Lithuania ( 20 ). Following the European ( 21 ) and North American guidelines ( 13 ), it is crucial to systematically assess the effectiveness of specific stroke education interventions and maintain the continuity of EMS education.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

et al. 2022

View full text Add to dashboard Cite

Background and PurposeAcute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania.MethodsWe conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas.ResultsIn total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1–2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1–2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621).ConclusionsThe interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

et al. 2022

View full text Add to dashboard Cite

show abstract

“…unfavourable) and causal relationship between the intake of dietary sodium and blood pressure is well established. High sodium intakes increase blood pressure and the risk of hypertension, which is a risk factor for CVD and chronic kidney disease (Williams et al, 2018 ; Arnett et al, 2019 ; EFSA NDA Panel, 2019b ; Visseren et al, 2021 ).…”

Section: Assessmentmentioning

confidence: 99%

“…A replacement of SFAs with refined carbohydrates (e.g. sugars) has not been shown to have an effect (Visseren et al, 2021 ). The inclusion of SFAs and (added/free) sugars in a nutrient‐profiling model could mostly account for the fatty acid profile of foods and for the less favourable replacement of SFAs by refined carbohydrates.…”

Section: Assessmentmentioning

confidence: 99%

Scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods

Turck¹,

Bohn²,

Castenmiller³

et al. 2022

EFS2

View full text Add to dashboard Cite

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta-analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food-Based Dietary Guidelines and associated nutrient/ food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category-based nutrient profiling models, total fat could replace energy in most food groups owing to its high-energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.

show abstract

“…Current guidelines recommend Aspirin for secondary prevention of cardiovascular disease (class I, level A recommendation), and Clopidogrel as an alternative in case of Aspirin resistance (IB recommendation) (1)(2)(3)(4)(5). It is also suggested that Clopidogrel may be considered in preference to Aspirin in patients with established atherosclerotic cardiovascular disease, but the class of this recommendation is not high (IIB) (1). Available data is still inconclusive on whether Aspirin monotherapy is more effective than other antiplatelet regimens in terms of mitigating morbidity and mortality (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Clopidogrel Monotherapy versus Aspirin Monotherapy in Patients with Established Cardiovascular Disease: Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

Background: The is no clear consensus on whether Aspirin offers better outcomes in terms of secondary cardiovascular disease prevention compared to Clopidogrel. Objective: The aim of the study was to compare the safety and efficacy of Clopidogrel versus Aspirin in patients with established cardiovascular disease. Patients/Methods: A systematic review of MEDLINE (via PubMed), Scopus, and Cochrane Library databases (last search date: August 28th, 2021) was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement for randomized control trials (RCTs) of Clopidogrel versus Aspirin as monotherapy in patients with established cardiovascular disease. Random-effects meta-analyses were performed. Results: Five RCTs incorporating 26,855 patients (Clopidogrel: 13,426; Aspirin: 13,429) were included. No statistically significant difference was observed between Clopidogrel and Aspirin in terms of all-cause mortality (odds ratio [OR]: 1.01 [95% Confidence Interval (95%CI):0.91-1.13]; p=0.83), ischemic stroke (OR: 0.87 [95%CI:0.71-1.06]; p=0.16) and major bleeding rates (OR: 0.77 [95%CI:0.56-1.06]; p=0.11). Patients receiving Clopidogrel had borderline lower risk for major adverse cardiovascular events (MACE) (OR: 0.84 [95%CI:0.71-1.00]; p=0.05) and lower risk for non-fatal myocardial infarction (OR: 0.83 [95%CI:0.71-0.97]; p=0.02, relative-risk-reduction=16.9%, absolute-risk-reduction=0.5%, number-needed-to-treat=217 for a mean period of 20 months) compared to patients receiving Aspirin. Conclusions: In patients with established cardiovascular disease, Clopidogrel was associated with a 17% relative-risk reduction for non-fatal MI, borderline decreased risk for MACE and similar risk for all-cause mortality, stroke and major bleeding compared to Aspirin. Keywords: Clopidogrel; Aspirin; monotherapy; cardiovascular disease; efficacy; myocardial infarction; stroke; mortality; safety; major bleeding

show abstract

Cited by 325 publications

References 506 publications

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods

Clopidogrel Monotherapy versus Aspirin Monotherapy in Patients with Established Cardiovascular Disease: Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About