心血管疾病预防指南解读New prevention guidelines deliver emphatic message
     8月29日,在ESC2012年会上。由9个不同学会(ESC,EAS,ISBM,ESO,ESH,EASD,ESCG,IDF-欧洲,以及EHN)组成的的大工作组,第五联合工作组,花两年时间完成的2012 ESC临床实践指南:心血管疾病的预防也已经在大会上公布。

       和2007版相比,新指南更简短并且更清晰。此外,新指南加入了众所周知的ESC建议的方法,一种平行分类GRADE。该方法允许被认为是偏倚、不一致或不正确的证据降级,或将不可能存在偏倚的观察性数据和正确一致的结果升级。这有助于在无法进行和解释健康行为随机临床试验时评估心血管疾病预防证据。


新指南的一处关键信息是,动脉粥样硬化性心血管疾病仍是全球死亡和发病的最大原因,但原则上是可预防的。
 
       尽管CVD死亡率在一些国家正在发生变化,但仍很高,并且在很多其他国家仍在上升。预防可发挥作用:在死亡率正在下降的国家,超过半数的CVD死亡率下降与危险因素的变化相关,40%与治疗改善相关。

      新指南围绕5个话题进行组织:什么是心血管疾病预防,为何需要预防,预防有哪些获益者,如何应用预防,应向哪些地方提供预防项目。上述5个主要部分中的每一个都以概述和关键信息开始。
 
      著名的SCORE系统得以保留,但被进一步优化,强调了去年的血脂指南所描述的HDL胆固醇和相对风险。
 
       综合所有信息——血脂、血压、亚临床疾病、器官损害—新指南定义了4类CVD风险:极高度、高度、中度和低度。新指南给出了降脂药、饮食、吸烟、运动和行为危险因素方面的可靠建议。读者阅读起来非常愉快,适合所有治疗心血管疾病患者的医务者阅读。
THE NEW ESC Guidelines on cardiovascular prevention from the Fifth Joint Task Force are the result of two years hard work from a broad group representing nine different societies: ESC, EAS, ISBM, ESO, ESH, EASD, ESCG, IDF-Europe, and EHN. The text was finally released at the Europrevent Congress in May and is now available online and with paginated  reference in the EHJ.

Compared to the 2007 version, the new guidelines are shorter and more concise. Furthermore, they add to the well-known ESC-recommended method a parallel classification GRADE, which allows downgrading of evidence considered biased, inconsistent, or imprecise, or upgrading  of observational data if bias is unlikely, and findings are consistent and precise. This is helpful in assessing evidence for cardiovascular disease prevention where randomised clinical trials of health behaviours are difficult to conduct and interpret.
 
One key message is that atherosclerotic cardiovascular disease remains the greatest cause of death and morbidity worldwide, but is in principle preventable.  
 
Although the rate of CVD mortality is changing in some countries, it remains high and is on the rise in many others. Prevention works: in countries with declining rates, more than 50% of the reductions seen in CVD mortality relates to changes in risk factors, and 40% to improved treatments.
 
The guideline is organised around five topics - what cardiovascular disease prevention is, why prevention is needed, who should benefit from it, how can it be used, and where should programmes be offered. Each of these five main sections begins with summaries and key messages. 
 
The well-known SCORE system is kept but further refined with emphasis on HDL-cholesterol and relative risk as outlined in last year’s lipid guideline.  
 
Bringing together all knowledge – from lipids, blood pressure, subclinical disease, organ damage – four classes of CVD risk are defined: very high, high, moderate, and low. Strong recommendations are given with respect to hypolipidemic medications, diet, smoking, exercise and behavioural risk factors. The guidelines make very enjoyable reading and should be read by all health providers caring for cardiovascular patients.

Authors: Christian Funck-Brentano & Per Anton Sirnes
ESC Congress News

For background information or independent comment, contact the ESC Press Office:
Tel: +33 (0)4 92 94 86 27.  Fax: +33 (0)4 92 94 77 51.  Email: press@escardio.org




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