World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

Abstract

Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article’s structure, content, and draft. Finally, an external expert group reviewed the paper. Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

Analysis of the Associations of Measurements of Body Composition and Inflammatory Factors with Cardiovascular Disease and Its Comorbidities in a Community-Based Study

“…CVD is a leading cause of morbidity, disability, and mortality worldwide [2]. Given the significant impact of CVD on public health, continued research is needed to improve prevention, diagnosis, and treatment strategies to reduce its burden.…”

“…Cardiovascular diseases (CVDs) encompass various disorders, including coronary artery disease (CAD), myocardial infarction (MI), angina pectoris, congestive heart failure (CHF), and rheumatic heart disease [1][2][3]. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide [4].…”

Objectively measured physical activity among people with and without HIV in Uganda: associations with cardiovascular risk and coronary artery disease

“…Importantly, objectively measured physical activity was low in this population in urban Uganda, as only 11% of participants overall achieved moderate-to-vigorous physical activity time of at least 150 minutes, with just 5% of females achieving this target. Several studies have demonstrated the all-cause and cardiovascular mortality benefit from achieving this level of physical activity 21 – 23 , and this target has been recommended by several international cardiovascular organizations for the mitigation of ASCVD 24 – 27 .…”

“…Importantly, objectively measured physical activity was low in this population in urban Uganda, as only 11% of participants overall achieved moderate-to-vigorous physical activity time of at least 150 minutes, with just 5% of females achieving this target. Several studies have demonstrated the all-cause and cardiovascular mortality benefit from achieving this level of physical activity [21][22][23] , and this target has been recommended by several international cardiovascular organizations for the mitigation of ASCVD [24][25][26][27] . A large volume of population-level evidence supports the reduction in ASCVD events with increased physical activity 28, [21][22][23] , and this benefit may be mediated by an inverse relationship between physical activity and sub-clinical cardiovascular disease 29 .…”