Cardiovascular prevention in clinical practice (ESC and German guidelines 2007).
Preventive efforts should be guided by the patient's global cardiovascular (CV) risk. A risk stratification should be done in every person > age 35 with more than a single risk factor. Recommendations for improved lifestyle are applicable to all persons with CV risk factors: smoking cessation, daily exercise, normal body mass index, Mediterranean diet, blood pressure < 140 mmHg systolic, and LDL cholesterol < 130 mg/dl are beneficial. If the 10-year risk is > or = 20% for CV events or > or = 5% for CV death, additional drug interventions are usually necessary: acetylsalicylic acid 100 mg daily, statins to lower LDL cholesterol to < 100 mg/dl or, in diabetics with coronary artery disease, to < 70 mg/dl, blood pressure should be < 130 mmHg systolic, e.g., in patients with diabetes or renal disease. After bare-metal stent implantation clopidogrel should be given for > or = 4 weeks and after drug-eluting stents for > or = 6 months. In patients after myocardial infarction with an ejection fraction of < 40%, ACE inhibitors and beta-blocker should be started. Influenza vaccination improves prognosis in high-risk patients.
Gohlke
Helmut
H
1Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. helmut.gohlke@herzzentrum.de
Albus
Christian
C
Gysan
Detlef Bernd
DB
Hahmann
Harry W
HW
Mathes
Peter
P
D002309:Cardiology / Q000592:standards*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011315:Preventive Medicine / Q000592:standards*