Management of CVD Risk Factors Behavioral Risk Factors

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Behavioral risk factors including diet, activity, and smoking are addressed in the new guidelines, which also suggest that recent surveys identified a significant gap between the recommendations provided and the advice given out by physicians in routine clinical practice (3). ESC guideline recommendations in these areas closely follow evidence-based practice guidelines as outlined in all guidelines referenced in this chapter; therefore, these will not be reviewed.

Lipid Management

Prior to the initiation of any therapies, secondary causes of dyslipidemia are ruled out including alcohol, diabetes, hypothyroidism, liver/kidney disease, and concurrent drug therapy. Using the recommendations from the SCORE chart, TC and LDL-C goals are used to guide the decision process and, in general, should be kept <190

Ckd LipidologyCkd Lipidology
Fig. 2. CVD risk-stratification method to guide therapeutic intervention in the European Community, the SCORE chart. Reproduced with permission (3).

and 115mg/dL, respectively. Although no treatment goals are defined for TGs and HDL-C, these values are used as risk markers of increased CVD risk. An HDL-C of <40mg/dL in men and <46mg/dL in women along with TG of >150mg/dL increase the patients' risk score. In those asymptomatic patients with high multifactorial risk as defined in the SCORE chart, the guidelines recommend a further reduction of TC to <175mg/dL and LDL-C to <100mg/dL using lipid-lowering drug therapy. In asymptomatic patients with a risk score of <5%, the risk assessment is repeated at 5-year intervals. If the risk score is >5%, the full lipid panel analysis is completed and interventions are prescribed (including intensive dietary changes exclusive of drug therapies) until the value for LDL-C falls <190mg/dL and TC falls <155mg/dL and the total CVD risk falls <5%. The patient is then monitored at yearly intervals. If, however, the total risk remains >5%, drug therapy is begun. The goals in this population are TC <175mg/dL and LDL-C <100mg/dL.


In general, treatment goals for patients with diabetes are more extensive and are represented in Table 3.

Metabolic Syndrome

The European Guidelines use the definition of metabolic syndrome as defined in the NCEP ATP III Guidelines. Although the guidelines suggest that patients with metabolic syndrome are usually at high risk of CVD, no specific guidelines exist beyond those described by the SCORE assessment guidelines.

The European Guidelines also suggest the following in the prevention of CHD in clinical practice:

Aspirin or other platelet-modifying drug therapy in virtually all patients with diagnosed CVD;

Beta-blockers following MI or in patients with left ventricular dysfunction related to CHD;

Table 3 Diabetic Treatment Goals


Table 3 Diabetic Treatment Goals




Venous plasma glucose

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