Task Force ReportPrevention of coronary heart disease in clinical practice: Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention1,2
Section snippets
Summary of recommendations
Since the first Joint European Societies—European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension—Task Force recommendations on coronary heart disease prevention in clinical practice were published in 1994 new scientific evidence has emerged in both secondary and primary coronary prevention, particularly in relation to lipid lowering. Therefore, a second Task Force was convened by the three major societies, including professional representatives from
Lifestyle
Lifestyle changes depend on the readiness of coronary and other high-risk patients to modify their behaviour. When patients develop symptoms of CHD, or are found to be at high risk, this is an ideal opportunity to review lifestyle. Many will consider making appropriate changes and, with professional and family support, can do so for life.
Estimation of coronary risk
The absolute risk of developing CHD (non-fatal CHD or coronary death) over the next 10 years can be estimated from the Coronary Risk Chart (Fig. 1) using gender, age, smoking status, systolic blood pressure and total cholesterol. For individuals whose absolute CHD risk is ≥20% over the next 10 years (or will exceed 20% if projected to age 60) intensive risk factor modification is recommended including, where appropriate, a selective use of proven drug therapies. Lifestyle intervention in this
General principles in the estimation of coronary heart disease risk
As CHD is multifactorial in origin it is important, in estimating CHD risk for an individual, to consider all the risk factors simultaneously. Traditionally, risk factor guidelines have focused on single factor assessment, particularly in the management of high blood pressure or hyperlipidaemia. This has resulted in undue emphasis being placed on elevations of single risk factors rather than on the overall level of risk based on a combination of risk factors. In practice, physicians deal with
Clinical opportunities for coronary prevention
Physicians are in an ideal position to encourage healthy lifestyle changes in a large section of the community. A majority of people visit their doctor once a year and research has shown that doctors are considered by society to be a credible and important source of information about the causes of CHD and other atherosclerotic disease, and how these diseases can be prevented. Some doctors view health promotion and disease prevention as an integral part of their role and many patients would like
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- 1
European Society of Cardiology, European Atherosclerosis Society, European Society of Hypertension, International Society of Behavioural Medicine, European Society of General Practice/Family Medicine, European Heart Network.
- 2
Published simultaneously in the European Heart Journal 1998;19:1434–1503 and the Journal of Hypertension (Summary only) 1998;16(10).
- 3
Members of the Task Force are listed in the Appendix.