The ESC Textbook of Preventive Cardiology: Clinical practice

369 Pages·2015·12.927 MB·English

by  Stephan Gielen, Guy De Backer, Massimo Piepoli, David Wood (eds.)

The ESC Textbook of
Preventive
Cardiology
European Society of Cardiology publications
The ESC Textbook of Cardiovascular Medicine (Second Edition)
Edited by A. John Camm, Thomas F. Lüscher, and Patrick W. Serruys
The EAE Textbook of Echocardiography
Editor-in-Chief: Leda Galiuto, with Co-editors: Luigi Badano, Kevin Fox, Rosa Sicari,
and José Luis Zamorano
The ESC Textbook of Intensive and Acute Cardiovascular Care (Second Edition)
Edited by Marco Tubaro, Pascal Vranckx, Susanna Price, and Christiaan Vrints
The ESC Textbook of Cardiovascular Imaging (Second Edition)
Edited by José Luis Zamorano, Jeroen Bax, Juhani Knuuti, Patrizio Lancellotti, Luigi
Badano, and Udo Sechtem
The ESC Textbook of Preventive Cardiology
Edited by Stephan Gielen, Guy De Backer, Massimo Piepoli, and David Wood
The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting: Case-based learning
with multiple choice questions
Edited by Haran Burri, Jean-Claude Deharo, and Carsten Israel
Forthcoming
The EACVI Echo Handbook
Edited by Patrizio Lancellotti and Bernard Cosyns
The ESC Handbook of Preventive Cardiology: Putting prevention into practice
Edited by Catriona Jennings, Ian Graham, and Stephan Gielen
The ESC Textbook of
Preventive
Cardiology
Edited by
Stephan Gielen
Guy De Backer
Massimo F. Piepoli
and
David Wood
1
3
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Foreword
Cardiovascular diseases represent the main cause of mortal- as hypercholesterolemia, hypertension, diabetes and smoking
ity worldwide, accounting for 36% of all deaths in the European should be a priority across the different countries. It is also im-
Union in 2010. A wide range of diseases related to the circula- portant to recognize the need for a tailored approach considering
tory system is responsible for this epidemic, with ischemic heart the differences between different countries, which reinforces the
disease (IHD) and cerebro-vascular disease (together comprising importance of putting surveillance systems in place that may be
60% of all cardiovascular deaths, and causing more than one-fifth able to properly monitor the need and implementation of prevent-
of all deaths in EU member states), as the main ones responsible. able measures.
The enormous advances in the field of cardiovascular medicine This is of crucial importance for a successful fight against in-
in the last few years have proven to be important in the decrease equality concerning access to appropriate healthcare in different
of mortality in many clinical conditions. However, the growing countries. The role of scientific societies in the dissemination
prevalence of several risk factors, such as hypertension, diabetes, of information and the promotion of different activities (for the
dyslipidemia, obesity, smoking and others, account for an increase public as well as the decision makers) can fill an important gap
in the prevalence and severity of cardiovascular disease. The in- in this regard. The ESC Textbook of Preventive Cardiology rep-
crease of some of these risk factors occurring in some regions resents a major achievement of our European Association of
more than others may partially explain the differences observed Cardiovascular Prevention and Rehabilitation (EACPR) and, of
between the different regions across the globe, and even within course, results from the hard work of the editors and outstanding
the same continent. There are underlying risk factors, such as diet, group of authors that have been able to put together a wonder-
which may explain differences in IHD mortality across countries. ful book that I am sure will become the key reference in the field.
For instance, across EU member states, IHD mortality rates in Whoever is involved in cardiovascular prevention (basically all
2010 were, on average, nearly double for men. health professionals should be) has, in this textbook, a reference
The impact of treatment improvement should therefore be ac- that goes from a more detailed description through to practical
companied by an absolute need to promote and improve healthy advice. I am sure this will represent another important element in
lifestyles and reduce the weight of the different risk factors, par- the road to improving and promoting healthy lifestyles and, con-
ticularly the ones that can be easily prevented if appropriate steps sequently, reduce the burden of cardiovascular disease in Europe
are taken (exercise, smoking, overweight/obesity, diabetes, hyper- and beyond.
tension and dyslipidemia).
Prof. Fausto J. Pinto, MD, PhD, FESCC, FACC
The relationship of prevention strategies with cardiovascu-
President, European Society of Cardiology (ESC)
lar events and death rates is clearly established through different
Cardiology Dpt, CCUL, CAML,
scientific studies. Therefore, the efficacy of primary prevention
programs in patients with recognized, treatable risk factors such University of Lisbon, Portugal
Preface
What is preventive cardiology? Guideline of the European Society of Cardiology (ESC) therefore
abolished the differentiation between primary and secondary pre-
Preventive cardiology, as the editors see it, encompasses all aspects
vention entirely and looked at the continuum of cardiovascular
of knowledge related to the prevention of premature cardiovascu-
risk instead. Because of the diversity of healthcare infrastructures,
lar disease—either its manifestation or its progression—with the
preventive cardiology separates the components of interventions
aim of averting life-threatening cardiovascular events and reduc-
(i.e. lifestyle changes, hypertension treatment, management of
ing cardiac mortality.
dyslipidaemia, etc.) from the actual setting of preventive care (i.e.
However, beyond the mere facts preventive cardiology also calls
acute care hospital, rehabilitation institution, community preven-
for a different approach to our patients: rather than focusing on
tion centre, etc.). The ESC Textbook of Preventive Cardiology follows
the resolution of an acute clinical problem (such as performing a
this structure because there is enormous variation in healthcare
revascularization intervention in an acute myocardial infarction)
delivery between ESC member states and beyond which deter-
preventive cardiology aims to influence the underlying systemic
mines how cardiovascular prevention is implemented. Whilst the
disease process of atherosclerosis, of which the acute events are
aim of prevention remains the same, the individual pathway for
just short manifestations. It focuses on the improvement of long-
implementation will differ between countries. In this book we give
term outcome rather than acute symptomatic relief, and accepts
different models from hospital-based rehabilitation to community
the fact that the modification of risk factors may have a greater
prevention programmes. Each country can adopt the modules that
impact on patient longevity than sophisticated interventions.
fit into the context and structure of its healthcare system.
Cardiovascular prevention faces the dilemma of multiple ter-
minologies coming from diverse historic backgrounds: Cardiac Who is the preventive cardiologist in clinical
rehabilitation, for example, was established as a combined med-
practice?
ical and economic intervention in the 1960s with the primary aim
of bringing patients after a myocardial infarction back into work. In contrast to terms like ‘interventional cardiologist’ a preventive
The focus here was to regain their previous exercise capacity. cardiologist does not depend on a single methodology to define
Secondary prevention relates to the comprehensive pharmaceut- his or her work. In fact everyone who takes a genuine interest in
ical and lifestyle interventions aimed at reducing event recurrence his or her patient’s well-being beyond acute care is a ‘prevention-
after a first acute coronary or vascular event. Primary preven- ist’. We address cardiovascular specialists, general physicians,
tion tries to identify and to manage individuals at high risk for general practitioners/family physicians, nurses, and allied health
developing atherosclerotic disease. Primordial prevention comes personnel in this textbook as they all have a role in prevention. The
from a public health perspective to influence the prevalence of overriding tone of the textbook is its devotion to clinical problem
risk factors in the general population and aims to prevent people solving. We have therefore introduced clinical cases at the begin-
from taking up risky behaviours in the first place. Each nation has ning of many chapters to illustrate how difficult it sometimes is to
its own historical background which is also manifest in different translate guideline recommendations into clinical practice.
insurance structures to pay for cardiovascular rehabilitation and
Why is this book needed?
prevention interventions.
The term preventive cardiology tries to bring these diverse back- In contrast to many other areas of cardiology, there is a limited
grounds together in a single approach. It also accepts the fact that choice of books on the implementation of cardiovascular preven-
the line separating primary and secondary prevention is increas- tion in clinical practice. There are academic textbooks focusing
ingly fading away. Novel imaging techniques identify subclinical on the epidemiological and pathophysiological aspects of pre-
atherosclerosis, and most patients with coronary artery disease vention and pocket-size checklists to optimize blood pressure or
are diagnosed before their first event. The Fifth Joint Task Force glucose control, but there is no book that unites all the specialist
preface vii
contributions from hypertension, dyslipidaemia, and diabetes rehabilitation in congenital heart disease). The online version will
into a single resource consistent with the respective guidelines also be updated when important new evidence is available.
that is accessible and well-structured. The practical hands-on ap-
How can you contribute to improving the book
proach is intended to give the reader the knowledge and tools to
tackle everyday clinical challenges. This textbook finds a balance further?
between science and practice.
The first edition of this textbook will not be perfect in all aspects,
A great challenge in prevention implementation is how to im-
and while reading through the chapters you may detect errors
prove patient adherence to recommendations for lifestyle change.
or disagree on certain issues. The Editors would welcome your
This book therefore contains a special chapter on behavioural
feedback on any aspects of the book that are pertinent to pre-
tools for optimizing patient adherence.
ventive cardiology in clinical practice. Our plan is to keep the
It provides much-needed guidance in controversial areas in car-
book as up to date as possible, so should you have suggestions
diovascular prevention such as the role of nutriceuticals, the role of
or ideas for improving the content in its print or online version
thresholds and target values in lipid lowering, how to interpret novel
please contact us directly, through the European Association for
risk factors (i.e. high-sensitivity C-reactive protein, lipoprotein(a),
Cardiovascular Prevention and Rehabilitation or via the publish-
and how to prudently use imaging in cardiovascular risk assessment
er, Oxford University Press. This is not a book to sit on your shelf;
and in monitoring subclinical disease.
it should become a c ompanion in your daily practice of prevent-
It answers the question ‘How much pain for the cardiac gain?’
ive cardiology.
with regard to the level of physical activity needed to lower mor-
tality and disease risks. Stephan Gielen
The content of the textbook is available in both print and digital Guy De Backer
form and the online version will provide direct access to the full Massimo F. Piepoli
text of cited publications and give additional educational material and
on specific important but rare problems (such as training-based David Wood
Contents
Abbreviations x 7 Primary prevention: principles and
practice 77
Contributors xiii
Diego Vanuzzo and Simona Giampaoli
8 Secondary prevention and cardiac
PART 1
rehabilitation: principles and practice 90
Epidemiology of atherosclerotic
Massimo F. Piepoli and Pantaleo Giannuzzi
cardiovascular disease
9 Behaviour and motivation 105
1 Epidemiology of atherosclerotic cardiovascular Christian Albus and Christoph Herrmann-Lingen
disease: scope of the problem and its
10 Smoking 112
determinants 3 Charlotta Pisinger and Serena Tonstad
Martin O’Flaherty, Susanna Sans-Menendez, Simon
Capewell, and Torben Jørgensen 11 Nutrition 125
Jean Dallongeville, Deborah Lycett, and Monique
PART 2 Verschuren
Aetiology and pathophysiology of 12 Physical activity and inactivity 140
atherosclerosis Stephan Gielen, Alessandro Mezzani, Paola Pontremoli,
Simone Binno, Giovanni Q. Villani, Massimo F. Piepoli,
2 Genetic background of atherosclerosis and its Josef Niebauer, and Daniel Forman
risk factors 21
13 Overweight, obesity, and abdominal
Lesca M. Holdt and Daniel Teupser
adiposity 175
3 From risk factors to plaque development and Gabriele Riccardi and Maria Masulli
plaque destabilization 26
14 Blood pressure 189
Ulf Landmesser and Wolfgang Koenig
Robert Fagard, Giuseppe Mancia, and Renata Cifkova
4 The role of thrombosis 30
15 Lipids 201
Elena M. Faioni, Maddalena Lettino, and Marco Cattaneo
Željko Reiner, Olov Wiklund, and John Betteridge
PART 3 16 Glucose intolerance and diabetes 214
Components of preventive cardiology Christina Jarnert, Linda Mellbin, Lars Rydén, and
Jaakko Tuomilehto
5 Risk stratification and risk assessment 39
17 Coagulation and thrombosis 228
Ian Graham, Marie Therese Cooney, and Dirk De Bacquer
Kurt Huber and Joao Morais
6 Imaging in cardiovascular prevention 54
18 Psychosocial factors in the prevention of
Uwe Nixdorff, Stephan Achenbach, Frank Bengel,
cardiovascular disease 238
Pompilio Faggiano, Sara Fernández, Christian Heiss,
Töres Theorell, Chantal Brisson, Michel Vézina, Alain
Thomas Mengden, Gian Francesco Mureddu, Eike Nagel,
Milot, and Mahée Gilbert-Ouimet
Valentina Puntmann, and Jose Zamorano
contents ix
19 Cardioprotective drugs 251 23 Ambulatory preventive care: outpatient clinics
Johan De Sutter, Miguel Mendes, and Oscar H. Franco and primary care 294
Jean-Paul Schmid and Hugo Saner
PART 4 24 Health promotion to improve cardiovascular
Setting and delivery of preventive health in the general population 303
cardiology Emer Shelley and Margaret E. Cupples
25 Community-based prevention centres 312
20 General remarks 273
Susan Connolly and Margaret E. Cupples
Pantaleo Giannuzzi
21 Acute care, immediate secondary prevention, PART 5
and referral 278 Evaluation of preventive cardiology
Ugo Corrà and Bernhard Rauch
26 Evaluation of preventive cardiology 323
22 Hospital-based rehabilitation units 285
Kornelia Kotseva, Neil Oldridge, and Massimo F. Piepoli
Heinz Völler, Rona Reibis, Bernhard Schwaab, and
Jean-Paul Schmid Index 343