Avril 2010
INTRODUCTION
For people identified as being at risk of cardiovascular disease (CVD), the degree or intensity of intervention is dictated by the predicted likelihood of a future coronary event. Assessment of cardiovascular risk factors is therefore essential so that individuals can be stratified as accurately as possible into ‘very high’, ‘high’ or ‘moderate-to-low’ risk categories. The high-risk category (Box 1) includes all those with established cardiovascular, cerebrovascular or peripheral vascular disease, or with diabetes; a subset of these regarded as ‘very high’ risk are targeted for more aggressive intervention (Box 2). Appropriate screening can also identify asymptomatic individuals who are considered to be at high risk because they have multiple risk factors. Although there is some variation between guidelines in the definition of ‘high cardiovascular risk’, this term usually refers to patients whose 10-year risk of an atherosclerotic coronary event (eg myocardial infarction) is ≥20% (see previous article in this series ‘Screening and identifying at-risk patients’). This article aims to provide practitioners with a concise guide to the management of high-risk patients based on recommendations from six of the most up-todate clinical practice guidelines for prevention of CVD (Box 3).1-7 We refer non-English speakers to the French Health Products Safety Agency and the Spanish local guidelines.8,9
[lire la publication]
For people identified as being at risk of cardiovascular disease (CVD), the degree or intensity of intervention is dictated by the predicted likelihood of a future coronary event. Assessment of cardiovascular risk factors is therefore essential so that individuals can be stratified as accurately as possible into ‘very high’, ‘high’ or ‘moderate-to-low’ risk categories. The high-risk category (Box 1) includes all those with established cardiovascular, cerebrovascular or peripheral vascular disease, or with diabetes; a subset of these regarded as ‘very high’ risk are targeted for more aggressive intervention (Box 2). Appropriate screening can also identify asymptomatic individuals who are considered to be at high risk because they have multiple risk factors. Although there is some variation between guidelines in the definition of ‘high cardiovascular risk’, this term usually refers to patients whose 10-year risk of an atherosclerotic coronary event (eg myocardial infarction) is ≥20% (see previous article in this series ‘Screening and identifying at-risk patients’). This article aims to provide practitioners with a concise guide to the management of high-risk patients based on recommendations from six of the most up-todate clinical practice guidelines for prevention of CVD (Box 3).1-7 We refer non-English speakers to the French Health Products Safety Agency and the Spanish local guidelines.8,9
[lire la publication]