ESC Congress 2016 - 6

FEATuREd ARTIclE Table 4. Risk-Factor Goals and Target Levels Risk Factor Recommendations Smoking No exposure to tobacco in any form Diet Low in saturated fat with a focus on whole grain products, vegetables, fruit, and fish Physical activity At least 150 min/wk of moderate aerobic activity (30 min, 5 d/wk) or 75 min/wk of vigorous aerobic activity (15 min 5 d/wk) or a combination thereof Body weight Body mass index 20-25 kg/m2; waist circumference < 94 cm (men) and < 80 cm (women) Blood pressure < 140/90 mm Hg Lipids LDL-C is primary target Very high-risk: < 1.8 mmol/L (< 70 mg/dL) or a reduction of at least 50% if the baseline is between 1.8 and 3.5 mmol/L (70 and 135 mg/dL) High-risk: < 2.6 mmol/L (< 100 mg/dL) or a reduction of at least 50% if the baseline is between 2.6 and 5.1 mmol/L (100 and 200 mg/dL) Low- to moderate-risk: < 3.0 mmol/L (115 mg/dL) HDL-C No target but > 1.0 mmol/L (> 40 mg/dL) in men and > 1.2 mmol/L (> 45 mg/dL) in women indicates lower risk Triglycerides No target but < 1.7 mmol/L (< 150 mg/dL) indicates lower risk and higher levels indicate a need to look for other risk factors Diabetes HbA1c: < 7% (< 53 mmol/mol) HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol. Adapted from Piepoli MF et a. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37: 2315-2381. doi:10.1093/eurheartj/ehw106. By permission of Oxford University Press on behalf of the European Society of Cardiology. Table 5. Lipid Risk Assessment Recommendations Recommendations Class Level Total cholesterol is to be used for estimation of total CV risk by means of the SCORE system. I C LDL-C is recommended to be used as the primary lipid analysis for screening, risk estimation, diagnosis, and management. HDL-C is a strong independent risk factor and is recommended to be used in the HeartScore algorithm. I C TG adds information to risk and is indicated for risk estimation. I C Non-HDL-C is a strong independent risk factor and should be considered as a risk marker, especially in subjects with high TG. I C Apolipoprotein B should be considered as an alternative risk marker whenever available, especially in subjects with high TG. IIa C Lipoprotein(a) should be considered in selected cases at high risk, in patients with a family history of premature CVD and for reclassification in subjects with borderline risk. IIa C The ratio apoB/apoA1 may be considered as an alternative analysis for risk estimation. IIa C The ratio non-HDL-C/HDL-C may be considered as an alternative but HDL-C used in HeartScore gives a better risk estimation. IIa C apoA1, apolipoprotein A1; apoB, apolipoprotein B; CV, cardiovascular; CVD, cardiovascular disease; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SCORE, Systematic Coronary Risk Evaluation; TG, triglyceride. Adapted from Catapano AL et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw272. By permission of Oxford University Press on behalf of the European Society of Cardiology. 6 October 2016 www.escardio.org/ESCcongressinreview http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2016