Primary Prevention of Cardiovascular Disease – What Happens in the Rest of the World?

Abstract

Background: Risk management thresholds for medication commencement for primary prevention of cardiovascular disease (CVD) remains controversial. Recent guidelines released in the UK and the United States (e.g. UK NICE and ACC/AHA guidelines) have added to this. In anticipation of new contemporary equations being available specifically for New Zealanders and a need to update our own guidelines, a systematic review was conducted looking at current international guidance and practice for the medical management of CVD Risk. Methods: The review focussed on recent quality assured international guidelines and systematic reviews published since the Primary care Handbook update in 2012, which included CVD risk assessment and management. It was outside the remit and scope of the review to look at individual trials or studies. The focus was on the primary prevention of CVD events and management of risk factors. Results/Conclusions: Fourteen international quality assured guidelines and six systematic reviews were identified and reviewed. A full summary of the results will be presented including:•A variety of thresholds for considering or recommending whether to treat medically with some using CVD Risk, some using individual risk values and others using a combination-NZ's higher CVD Risk threshold for considering or recommending medications to treat at approximately double the risk of contemporary international guidelines-Most recommend tailoring medications to reach a target but some not-When treating to a target varying views on what those targets should be-Equivocal views on risk communication and medication adherence-Identification of mental health as a CVD risk factor