European cardiovascular prevention guidelines emphasise population approaches

May 28 2016

By Eleanor McDermid

The European Society of Cardiology (ESC) has updated its cardiovascular disease (CVD) prevention guidelines to include, for the first time, population approaches to be implemented by legislators, schools and workplaces.

Task Force Chairperson, Massimo Piepoli (Polichirurgico Hospital G Da Saliceto, Piacenza, Italy) told the press: "A healthy environment is essential for preventing CVD. Lawmakers need to take more responsibility for their nation's wellbeing by taxing unhealthy choices and incentivising healthy ones."

The guidelines Task Force members represent 10 societies, including the ESC, and the guidelines are published in the European Heart Journal, as well as in various specialty journals.

The new inclusion of population approaches is based on the reasoning that "small shifts in the risk of disease (or risk factor) across a whole population consistently lead to greater reductions in disease burden than a large shift in high-risk individuals only."

The Task Force writes: "This population-wide approach has further advantages: it addresses CV health over the entire life course and reduces health inequalities."

Their population-level recommendations cover diet, physical activity, smoking, alcohol abuse and healthy environment (eg, air pollution). The approaches cover government, media and education, labelling and information, economic incentives, schools, workplaces and community settings.

For obesity, for example, recommended government interventions include legislation to reduce salt, fat and added sugar content and to reduce portion sizes; and economic incentives include pricing and subsidy strategies to promote healthier food and taxes to discourage less healthy food purchases. School-based interventions include the promotion of a healthy diet starting from pre-school and provision of water and healthy vending-machine food, and, for community settings, legislation is recommended to regulate the location and density of fast-food outlets.

The Task Force notes that randomised controlled trials are rarely feasible for population-level strategies, so they have taken "consistent findings from several high-quality studies" as a basis for strong recommendations.

At an individual level, the guidelines now include the advice that rheumatoid arthritis should be factored into calculations of CV risk, and that CV risk should be assessed in men with erectile dysfunction.

There are two recommendations for patients with cancer. First, that prophylactic treatment should be considered to prevent left ventricular dysfunction in patients receiving type I chemotherapy, and, second, that physicians should seek to optimise the CV risk profile of cancer survivors.

The guidelines also address the link between certain female-specific conditions and CV risk, advising periodic screening for diabetes and hypertension in women who have experienced pre-eclampsia or polycystic ovary syndrome, and potentially in those with a history of premature birth.

Task Force Co-chairperson Arno Hoes (University Medical Center Utrecht, the Netherlands) commented: "The recommendations cover the entire spectrum of CVD prevention in individuals and populations. We all have a role to play to stop heart disease."

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