Primary prevention
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020Except for familial causes of hypercholesterolaemia, the disease is completely preventable and largely related to the lifestyle in many high-income countries. Therefore, the adoption of a healthier lifestyle, including a low-fat diet and a reasonable amount of aerobic exercise, has a large impact on the prevalence of hypercholesterolaemia, as well as of obesity and coronary heart disease.[30][31] The US Preventive Services Task Force recommends that adults at increased risk of cardiovascular disease are offered behavioural counselling interventions to promote a healthy diet and physical activity; those not at high risk may also be considered for behavioural counselling interventions.[32][33]
Secondary prevention
Dietary reduction in total and saturated fat, weight loss in overweight patients, aerobic exercise, and the addition of plant stanols/sterols to the diet leads to a decrease in low-density lipoprotein cholesterol (LDL-C) and an increase in high-density lipoprotein cholesterol.[30][63][64][65] High-intensity statin is generally recommended in secondary prevention across guidelines, unless otherwise contraindicated.[41][44][51] In the US, alirocumab is approved for use in the reduction of risk of myocardial infarction, stroke, and unstable angina requiring hospitalisation in adults with established cardiovascular disease, and evolocumab is approved for use in the reduction of risk of myocardial infarction, stroke, and coronary revascularisation in adults with established cardiovascular disease. In Europe, alirocumab and evolocumab are indicated in adults with established atherosclerotic cardiovascular disease to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors.
Patients should be assessed for the presence of additional cardiovascular risk factors, such as smoking and diabetes, and appropriate management of these risk factors initiated.
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