[Individualized cardiovascular prevention: when and how far should it go?]

Abstract

Individualised cardiovascular prevention must primarily be applied to patients with coronary heart disease or another obvious atherosclerotic disease and to apparently healthy subjects, but presenting a high risk (which implies the detection of these subjects) and their close relatives. The European recommendations for the prevention of coronary heart disease in clinical practice have been recently up-dated. Calculation of the multifactorial absolute risk (probability of developing an event over a given period, taking into account all modifiable and non-modifiable risk factors) represents a decisional aid to intervene on lifestyle and drug prescription. However, the available tables and software require certain adjustments. Diet is a major determinant of the cardiovascular risk and has one of the most important, but most complex impacts on prevention. Restriction of saturated fats, a Mediterranean type of diet and caloric restriction in the case of obesity are the main objectives. Smoking cessation is essential. For all these measures, a specialist referral is too frequently neglected. Aerobic physical activity is recommended. Hypertension must be controlled regardless of age. The objective is to obtain blood pressure figures less than 140/90 mmHg, and even lower in the case of diabetes or renal disease. Evidence of the benefit of controlling hypercholesterolaemia has been reinforced and the objectives to be achieved have been redefined: in secondary prevention and in high-risk subjects, the target total cholesterol must be less than 1.90 g/l and LDL cholesterol must be less than 1.15 g/l. The control of all risk factors must be reinforced in diabetic patients and fasting blood glucose must be maintained between 0.91 and 1.20 g/l in insulin-dependent diabetic patients with coronary heart disease.