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2021 ESC Guidelines on Cardiovascular Disease Prevention

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2021 ESC Guidelines on Cardiovascular Disease Prevention ESC GUIDELINES European Heart Journal (2021) 00,1À111 doi:10.1093/eurheartj/ehab484 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice Downloaded from https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab484/6358713 by guest on 30 August 2021 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) Authors/Task Force Members: Frank L.J. Visseren* (Chairperson) (Netherlands), Franc¸ois Mach* (Chairperson) (Switzerland), Yvo M. Smulders† (Task Force Coordinator) (Netherlands), David Carballo† (Task Force Coordinator) (Switzerland), Konstantinos C. Koskinas (Switzerland), Maria Back€ (Sweden), Athanase Benetos8 (France), Alessandro Biffi7,10 (Italy), Jose´-ManuelBoavida9 (Portugal), Davide Capodanno (Italy), Bernard Cosyns (Belgium), Carolyn Crawford (Northern Ireland), Constantinos H. Davos (Greece), Ileana Desormais (France), Emanuele Di Angelantonio (United Kingdom), Oscar H. Franco (Switzerland), Sigrun Halvorsen(Norway),F.D.RichardHobbs13 (United Kingdom), Monika Hollander (Netherlands), Ewa A. Jankowska (Poland), Matthias Michal11 (Germany), Simona Sacco6 (Italy), Naveed Sattar (United Kingdom), Lale Tokgozoglu2 (Turkey), Serena Tonstad (Norway), Konstantinos P.Tsioufis5 (Greece), Ineke van Dis3 (Netherlands), Isabelle C. van Gelder (Netherlands), Christoph Wanner4 (Germany), Bryan Williams (United Kingdom), ESC Scientific Document Group * Corresponding authors: The two chairpersons contributed equally to the document. Frank Visseren, Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. Tel: þ31 (0)88 7557324, E-mail: [email protected]. Franc¸ois Mach, Cardiology Department, Geneva University Hospital, Perret-Gentil 4, 1211 Geneva, Switzerland. Tel: þ41 (0)22 372 71 92, E-mail: [email protected]. † The two task force coordinators contributed equally to the document. Author/Task Force Member affiliations: listed in Author information. ESC Clinical Practice Guidelines Committee (CPG): listed in the Appendix. ESC subspecialty communities having participated in the development of this document. Associations: Association of Cardiovascular Nursing & Allied Professions (ACNAP), European Association of Cardiovascular Imaging (EACVI), European Association of Preventive Cardiology (EAPC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA). Councils: Council on Valvular Heart Disease. Working Groups: Aorta and Peripheral Vascular Diseases, Atherosclerosis and Vascular Biology, Cardiovascular Pharmacotherapy. Patient Forum The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC ([email protected]). Disclaimer: The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommen- dations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate deci- sions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. This article has been co-published with permission in the European Heart Journal and the European Journal of Preventive Cardiology. VC The European Society of Cardiology 2021. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article. For ermissions, please email: [email protected]. 2 ESC Guidelines Document Reviewers: Guy De Backer (CPG Review Coordinator) (Belgium), Vera Regitz-Zagrosek (CPG Review Coordinator) (Germany), Anne Hege Aamodt6 (Norway), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Christian Albus11 (Germany), Riccardo Asteggiano (Italy), Magnus Back€ (Sweden), Michael A. Borger (Germany), Carlos Brotons13 (Spain), Jelena Celutkien e_ (Lithuania), Renata Cifkova (Czech Republic), Maja Cikes (Croatia), Francesco Cosentino (Italy), Nikolaos Dagres (Germany), Tine De Backer (Belgium), Dirk De Bacquer (Belgium), Victoria Delgado (Netherlands), Hester Den Ruijter (Netherlands), Paul Dendale (Belgium), Heinz Drexel (Austria), Volkmar Falk (Germany), Laurent Fauchier (France), Brian A. Ference (United Kingdom), Jean Ferrie` res (France), Marc 1 4 Ferrini (France), Miles Fisher (United Kingdom), Danilo Fliser (Germany), Zlatko Fras (Slovenia), Dan Downloaded from https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab484/6358713 by guest on 30 August 2021 Gaita3 (Romania), Simona Giampaoli (Italy), Stephan Gielen (Germany), Ian Graham (Ireland), Catriona Jennings (Ireland), Torben Jorgensen (Denmark), Alexandra Kautzky-Willer12 (Austria), Maryam Kavousi (Netherlands), Wolfgang Koenig (Germany), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ulf Landmesser (Germany), Madalena Lettino (Italy), Basil S. Lewis (Israel), Ales Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Konstantinos Makrilakis9 (Greece), Giuseppe Mancia5 (Italy), Pedro Marques-Vidal (Switzerland), John William McEvoy (Ireland), Paul McGreavy (United Kingdom), Bela Merkely (Hungary), Lis Neubeck (United Kingdom), Jens Cosedis Nielsen (Denmark), Joep Perk (Sweden), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Massimo Piepoli (Italy), Nana Goar Pogosova (Russia), Eva Irene Bossano Prescott (Denmark), Kausik K. Ray2 (United Kingdom), Zeljko Reiner (Croatia), Dimitrios J. Richter (Greece), Lars Ryde´ n (Sweden), Evgeny Shlyakhto (Russia), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Isabella Sudano (Switzerland), Monica Tiberi7,10 (Italy), Rhian M. Touyz (United Kingdom), Andrea Ungar8 (Italy), W.M. Monique Verschuren (Netherlands), Olov Wiklund (Sweden), David Wood (United Kingdom/Ireland), Jose Luis Zamorano (Spain) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines Collaborating and endorsing societies: 1European Association for the Study of Diabetes (EASD); 2European Atherosclerosis Society (EAS); 3European Heart Network (EHN); 4European Renal Association - European Dialysis and Transplant Association (ERA-EDTA); 5European Society of Hypertension (ESH); 6European Stroke Organization (ESO); 7European Federation of Sports Medicine Association (EFSMA); 8European Geriatric Medicine Society (EuGMS); 9International Diabetes Federation Europe (IDF Europe); 10International Federation of Sport Medicine (FIMS); 11International Society of Behavioural Medicine (ISBM); 12International Society of Gender Medicine (IGM); 13World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) À Europe ................................................................................................................................................................................................... Keywords Guidelines • prevention • personalized • population • risk estimation • lifetime risk • lifetime benefit • risk management • shared decision-making • stepwise approach • nutrition • smoking • healthy lifestyle • psychosocial factors • blood pressure • lipids • diabetes • smoking • air pollution • climate change . Table of Contents . 3.2.1.3 Cigarette smoking .................................... 16 . 3.2.1.4 Diabetes mellitus ..................................... 17 1.Preamble ........................................................ 7 . 3.2.1.5 Adiposity ............................................ 17 2.Introduction ....................................................
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