[The role and significance of vascular aging in the risk stratification of cardiovascular prevention]
VÉRTES András
JUNE 20, 2011
Lege Artis Medicinae - 2011;21(06-07)
VÉRTES András
JUNE 20, 2011
Lege Artis Medicinae - 2011;21(06-07)
[The structure and function of arteries change throughout one’s lifetime. The most important changes include lumenal dilation, diffuse intimal and medial thickening, increased stiffness, reduced compliance of central arteries and endothelial dysfunction. Arterial stiffness, an increased pulse wave velocity (PWV) and an increased carotid intima-media thickness (IMT) are independent predictors of cardiovascular events. The early vascular aging (EVA) could help clinicians to determine the increased cardiovascular risk. EVA can be be determined by noninvasive methods, as arterial stiffness and carotid IMT. EVA can be suitable for the early detection of cardiovascular diseases.]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]
Lege Artis Medicinae
[In August 2021, the European Society of Cardiology (ESC) published its practical guidelines for cardiovascular prevention. In Part 1 of our publication, we discussed cardiovascular risk factors, risk assessment, cardiovascular risk assessment in presumably healthy individuals of different ages, people with proven atherosclerotic cardiovascular disease, people with diabetes mellitus, and factors influencing risk. In Part 2, conditions that influence cardiovascular risk were detailed. In the current Part 3 of this publication, we review personalised cardiovascular prevention, non-pharmaceutical and pharmaceutical treatment of specific risk factors, emerging treatment options, and participation in cardiovascular rehabilitation and prevention programmes based on ESC guidelines.]
Lege Artis Medicinae
[In our four-part publication we review the current state of cardiovascular prevention based on the European Society of Cardiology Guidelines 2021. In part 1 we reviewed the risk factors, risk assessment, age-specificities, the influencing factors, including diabetes mellitus and chronic kidney disease. In part 2 we concerned comorbidities affecting the cardiovascular risk. In part 3 we reviewed the personalised cardiovascular prevention and the management of specific risk factors, including optimisation of life style factors, management of lipid levels and high blood pressure and antithrombotic therapy. This part 4, we review the community level preventive measures (physical activity, diet, smoking habits and alcohol consumption) and the importance of governmental and non-governmental interventions. We provide a brief summary about the principles of cardiovascular prevention in individuals with coronary artery disaese, heart failure, cerebrovascular diseases, lower extremity artery disaese, chronic kidney disease, atrial fibrillation, and in multimorbid patients.]
Lege Artis Medicinae
[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, while taking into account also the patient’s preferences.]
Hypertension and nephrology
[The primary aim of cardiovascular prevention is to reach adequate blood pressure control. To prevent the development of target organ lesion it is essential to use long-acting, well tolerable drugs without significant side effects. Angiotensin-converting enzyme (ACE) inhibitors are popular and excellent preparations but their side effects reduce life long patient compliance. Angiotensin II receptor blockers (ARBs) are effective drugs having unique tolerability and a capability to reduce cardiovascular morbidity and mortality to the same extent as the ACE inhibitors. Especially high risk patients benefit from their combination with thiazide diuretics or with calcium channel blockers. Clinical trials proved that telmisartan can be safely given and well tolerable alone or in combination to high risk cardiovascular patients, in heart and renal, peripheral vascular and cerebrovascular diseases combined or not with diabetes.]
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