2021 guidelines on CVD prevention recommend stepwise approach for prevention goals

Presented at the digital ESC Congress 2021, chaired by Frank Visseren (Utrecht, The Netherlands), Colin Baigent (Oxford, UK) and Konstantinos Koskinas (Bern, Switzerland).

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The Task Force set out to make a single guideline for all, primary care and hospital care, to follow and support clinical practice. They also aimed for more personalized CVD prevention in the guidelines, instead of a one-size fits all.

The guidelines consist of recommendations for CVD prevention at the individual level and at the population level. At the individual level they are aimed at apparently healthy people, patients with established ASCVD, people with diabetes, familial hypercholesterolemia, and chronic kidney disease. Recommendations at the population level are aimed at public health policy, interventions and environment.

Targets for LDL-c (lipids), blood pressure and glycemic control remain unchanged in the new guidelines compared to recent ESC guidelines on dyslipidemia, hypertension and diabetes. New is the introduction of a stepwise approach to intensify preventive treatments, while taking into account benefits, other conditions, psychosocial factors and patient’ preferences. Step 1 is prevention goals for all and step 2 consists of intensified prevention and treatment goals, tailored based on 10-years risk of CVD. Another new section pays attention to the communication of risk in the shared decision making process in order for individuals to understand their risk, the anticipated risk reduction with treatments, the pros and cons of intervention and their individuals priorities.

Other new concepts in the 2021 guidelines include

• Use of SCORE2 and SCORE2-OP (older persons) risk charts for 4 geographic risk regions (based on WHO CV mortality rates)
• Age-specific risk thresholds in apparently healthy persons
• Estimation of lifetime CVD risk and treatment benefit as an option
• Recommendation on environment
• Signaling potential costs issues

The new guidelines on CVD prevention in clinical practice were simultaneously published in Eur Heart J.