New guidelines released for the prevention of cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death worldwide and is considered a global health problem. Extensive research has identified contributing risk factors to CVD such as smoking, high blood pressure, cholesterol abnormalities, elevated glucose and advancing age. It is important that all countries have appropriate strategies to address these risk factors and reduce the burden of CVD on society. A task force of researchers of the World Health and Stroke form (WHF) has therefore provided a detailed report explaining principles involved in CVD prevention and offered specific recommendations to help countries establish national clinical guidelines. Hopefully with such knowledge, policy makers worldwide can benefit, so they can better address the growing international problem of CVD.

Cardiovascular disease (CVD) is the leading cause of death worldwide and creates major health burdens in all countries. The prevalence and burden of CVD is set to increase given the aging of the population and the decline in other diseases such as infections and nutritional disorders. Particular attention must be given to the prevention of CVD through targeting at risk individuals and creating population strategies to address identified risk factors and lifestyles. The World Heart and Stroke Forum (WHSF) Guidelines Task Force of the World Heart Federation (WHF) has therefore provided recommendations to act as a template for the development of national clinical guidelines. Hopefully, the publishing of such data will lead to all countries developing strategic methods for CVD prevention and in turn reduce the worldwide suffering and mortality associated with the disease. The report highlights established major and minor risk factors for CVD and the concept of total CVD risk relevant in the interpretation and management of patients. In particular, tobacco smoking, hypertension, elevated serum LDL cholesterol, diabetes, low HDL cholesterol and advancing age are identified as key risk factors in several epidemiologic studies. Those with multiple risk factors are at significantly increased risk of new CVD events. Thus, evidence based guidelines are needed to reliably address such risks. In addition, there are other underlying risk factors such as obesity, physical inactivity, atherogenic diet, family history and genetic and racial factors that may alter CVD risk on a population sense but the individual impact is not well established by clinical trials. The current recommendations of the WHSF of the WHF focus on addressing these known risk factors in those at high risk or with established CVD. The importance of population wide and society measures such as reducing tobacco use, improving diet and encouraging weight reduction and exercise is also strongly emphasised.Researchers at the World Health and Stroke Forum identified total CVD risk as the most important factor to base interventions. If reliable methods are available to identify those at greatest risk, the cost and efficacy of treatment can be improved. They suggested that ‘giving priority in risk-reduction therapies to patients at higher total risk will produce a substantial reduction in total CVD events,’ and that ‘more high-risk individuals will benefit.’ However, health policies must have an appropriate balance between prevention strategies and treatment of existing disease. The overall objective of national clinical guidelines should be to reduce the risk of subsequent major CVD events. All health professionals should set appropriate examples for their patients and incorporate prevention of CVD as part of their daily practice. Clinical interventions should focus on aspects of lifestyle, blood pressure, lipids, and diabetes and the used of prophylactic medications (including aspirin, B-blockers, ACE inhibitors, and LDL lowering drugs) in reducing overall CVD risk. CVD risk factors are common across all countries but methods to address these issues will differ for cultural, social, medical and economic reasons. The report from the WHSF therefore aimed to highlight important principles to be considered in forming national guidelines. Key recommendations from this report focused on collaboration between governments, national societies and foundations in the formation of clinical guidelines and prevention of CVD risk factors. Strategies to develop evidence-based guidelines based on overall population risks are necessary, as well as timely follow-up and statistics to measure the response. The strategies used must be culturally and financially appropriate for the given country. It is important to note the recommendations are primarily of a clinical focus, and overall population strategies, perhaps the most important aspect of preventive cardiology, are not addressed. However, previous published reports from the World Health Organisation have focused on this aspect. (Source: Smith et al. “Principles for National and Regional Guidelines on Cardiovascular Disease Prevention – A Scientific Statement from the World Heart and Stroke Forum,” American Heart Association 2004. DOI: 10.1161/01.CIR.0000133427.35111.67.)