Commentary of the CEIPV on the new 2021 European guidelines for cardiovascular prevention

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention.

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. In addition to an individualised approach, the current guidelines strongly emphasize the importance of health policy as a population prevention strategy.

Routine CVD risk assessment is recommended in all adult individuals with a vascular risk factor. Treatment goals and targets for LDL cholesterol, blood pressure and glycaemic control in patients with diabetes mellitus have not changed from those in previous guidelines, although a stepwise approach (steps 1 and 2) is now being proposed. It is recommended to always reach step 2, with treatment intensification based on risk at 10 years and throughout life, the benefits of treatment, comorbidities, fragility and the preferences of the patient. For the first time, the guidelines propose a new model (SCORE 2 and SCORE2-OP) to assess the risk of fatal and non-fatal vascular events in the next 10 years (myocardial infarction, stroke and vascular mortality) in healthy men and women aged 40-89 years. Another important novelty is the establishment of different risk based on age (<50, 50-69, ≥70 years).

The guidelines provide different algorithms for assessment of CVD risk and management of risk factors in apparently healthy persons, patients with diabetes and patients with known atherosclerotic CVD. Patients with chronic kidney disease are considered to be at high or very high-risk based on the glomerular filtration rate and albumin-to-creatinine ratio. They also include new lifestyle recommendations, adapted to those published by the Spanish Ministry of Health, as well as novel aspects concerning the control of lipid levels, blood pressure, diabetes and chronic renal failure.