Society Of Cardiology Research Articles

Reducing the Cardiovascular Risks of Smoking: Insights From the European Society of Cardiology (ESC) Congress 2024 and Two Key Opinion Leaders

Smoking is a major risk factor for cardiovascular disease (CVD) and responsible for around 25% of all CVD-related deaths worldwide. Cigarette combustion releases nicotine and produces thousands of chemicals, many of which are toxic. Complete cessation of smoking is the most effective way of reducing the associated CVD risk. However, many people find it difficult to quit smoking due to nicotine’s addictive nature and the ritualistic aspect of smoking. The European Society of Cardiology Congress (ESC) 2024, held in London, UK, between 30th August–2nd September, included several sessions discussing tobacco harm reduction in relation to CVD, with a particular focus on e-cigarettes and heat-not-burn products (HNBP) as alternatives to cigarettes. EMJ interviewed two key opinion leaders (KOL), who had attended ESC 2024, to obtain their insights into tobacco harm reduction in Europe: Vincenzo Montemurro, Professor and Consultant Cardiologist at the Scilla Hospital of America, Reggio Calabria, Italy; and Emil Toldy-Schedel, Professor, Consultant Cardiologist, and General Director of the St. Francis Hospital, Budapest, Hungary. Montemurro explained that switching from cigarettes to alternative products that generate fewer toxins would likely reduce CVD risk in people who are unable to quit smoking, which would benefit public health and decrease healthcare expenditure in Europe. Toldy-Schedel agreed with this view but called for well-designed studies to fully characterise the risk profile of these newer products so that healthcare professionals can be better equipped to answer patients’ questions about possible long-term effects.

Evaluation of Adherence to European Society of Cardiology Guidelines for Heart Failure Patients in Shahid Modarres Hospital

Background: The prevalence of heart failure (HF) presents a significant burden on global healthcare systems, accounting for approximately 1.2% of the total healthcare budget. Adherence to the European Society of Cardiology (ESC) guidelines is associated with improved clinical outcomes, fewer cardiovascular hospitalizations, and delayed rehospitalization. Objectives: Given the lack of studies on compliance with ESC guidelines for HF patients in Iranian hospitals, this study aimed to evaluate the compliance of HF treatment at Shahid Modarres Hospital with the ESC guidelines. Methods: This descriptive cross-sectional study was conducted on 97 patients with HF who were referred to Shahid Modarres Hospital, Tehran, in 2023. Patients were diagnosed based on their medical records and clinical evaluations by a cardiologist. Medications were reviewed for compliance with the ESC guidelines regarding drug category, type, and dosage. Results: The results showed that 42.3% of patients received treatment in compliance with the ESC guidelines, while 57.7% had non-compliance. The most common non-adherence was observed in the use of ACE/ARB, mineralocorticoid receptor antagonists (MRAs), and Empa/Dapa drug combinations. The study found that 57% of patients were already being treated at Modarres Hospital, and treatment compliance was higher among these patients (60%), compared to those who referred to the hospital for the first time (30%). Conclusions: Although the HF treatment compliance rate at Shahid Modarres Hospital is high, it still requires improvement. A thorough examination of the underlying reasons for non-adherence to HF medication guidelines is needed, with the goal of identifying and addressing potential barriers to optimal treatment.

Reassessing cardiovascular risk stratification in men with erectile dysfunction.

Erectile dysfunction (ED) is an independent and strong marker of cardiovascular disease (CVD) risk. The Princeton Consensus aimed to evaluate and manage cardiovascular risk in men with ED and no known cardiovascular disease, focusing on identifying those requiring additional cardiologic work-up. It has recently been updated to the American population demographics, but European recommendations are needed. It was developed a cross-sectional investigation including erectile dysfunction patients. Data were collected from hospital registries. Two risk stratification models were employed and compared: Princeton Consensus Criteria (PC) and European Society of Cardiology (ESC) CVD Risk Criteria. The objective was to stress the importance of the changes in IV Princeton Consensus recommendations in stratifying CVD risk in men with erectile dysfunction using a model validated in European men. A total of 137 patients with ED, with a mean age of 57.1 years old, were included. According to the PC criteria, 39.7% of the patients were "Low Risk". When using ESC criteria, the proportion of "Low Risk" patients were significantly lower (12%, p < 0.05). Among "Low Risk" patients according to the PC, 52.5% and 20% were classified as High and Very high risk according to ESC criteria, respectively. One myocardial infarction was reported. The patient was classified as "Low Risk" according to the PC, but the ESC criteria categorized him as "high risk". PC is less sensitive than ESC recommendations detecting CVD. It raises concerns that Urologists could be overlooking patients with undiagnosed CVD, consequently missing out on opportunities for prevention of major cardiovascular events (MACEs) and premature deaths.

Role of Multimodal Imaging in Clinical Practice for the Diagnosis of Infective Endocarditis: A Case Series

Background: The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) highlighted the essential role of multimodal imaging in the diagnostic algorithm of IE and its complications. Methods: We hereby report a case series of IE in which the diagnosis was confirmed or excluded by the use of multimodal imaging during the period between January 2024 and July 2024 at the Infectious Diseases Clinic, Perugia Hospital, Italy. Results: Six patients were retrospectively included. Prosthetic valve endocarditis (PVE) was suspected in four patients and native valve endocarditis (NVE) in two cases. In patients with prosthetic valves, 18F FDG-PET/CT was performed, except in one case (P1) where cardiac CTA was performed for suspicion of perigraft aneurysm. Patients underwent transesophageal echocardiography (TOE), which was diagnostic in two cases and inconclusive in the remaining cases. In case of inconclusive TOE, the use of multimodal imaging added a major criterion and allowed us to consider (from ‘rejected’ to ‘possible’) or confirm (from ‘possible’ to ‘definite’) the diagnosis of EI based on the 2023 Duke–ESC Criteria. In one case (P6), it was possible to exclude the diagnosis. For patients with diagnostic TOE, 18F FDG-PET/CT allowed for the enhancement of diagnostic accuracy, identifying the site of valve involvement and the extension of the infection to the device (cases P3 and P5, respectively). Conclusions: In clinical practice, the use of cardiac CTA and/or 18F FDG-PET/CT based on the latest ESC guidelines demonstrated a significant impact on the diagnosis and therapeutic management of IE.

Clinical practice guidelines for the management of hypertension in China.

International Practice Guidelines Registry Platform, http://www.guidelines-registry.cn/, No. IPGRP-2021CN346.

Exercise and fitness quantification in clinical practice: why and how; and where are we going?

Exercise and fitness quantification is increasingly recognized as a critical component in clinical practice, particularly within preventive cardiology. This article explores the multifaceted importance of exercise quantification in clinical settings, addressing preventive care, cost-effectiveness, psychosocial benefits, treatment planning, and monitoring progress. Quantifying exercise habits allows clinicians to evaluate risk profiles, prescribe tailored interventions, and monitor patient progress. The methodologies for exercise quantification are discussed. In preventive cardiology, adherence to guidelines from organizations such as the American Heart Association, the European Society of Cardiology, and the Canadian Cardiovascular Society is emphasized, with particular focus on high-intensity interval training and the central role of physical therapists/kinesiologists. Special populations, such as weekend warriors, the "fat and fit" concept, athletes, and those at risk of overtraining syndrome, are considered in prescribing exercise. Future directions in exercise and fitness quantification include the integration of advanced wearable technology, personalized medicine, telemedicine, and the promotion of active, walkable communities. The incorporation of behavioral science is highlighted as a missing component that can enhance long-term adherence to exercise regimens through motivation, behavior change techniques, patient-centered approaches, and continuous monitoring and feedback. This comprehensive approach aims to optimize cardiovascular health and overall well-being through individualized, evidence-based exercise interventions that are both effective and sustainable.

International Cardiovascular Development, Anatomy, and Regeneration (ICDAR) Community Meeting: Prague 2024

The International Cardiovascular Anatomy, Development, and Regeneration meeting was held from 18–20 September 2024, in Prague, Czech Republic, supported by the European Society of Cardiology’s Working Group on Development, Anatomy, and Pathology. Hosted at the Institute of Anatomy, First Faculty of Medicine, the event began with a hands-on workshop on normal and malformed human hearts, covering morphology, echocardiographic imaging, and rare congenital cases. The session allowed participants to examine and image both normal and malformed hearts. The main conference featured nine platform sessions on topics including pediatric cardiology, cardiac progenitors biology, congenital heart disease mechanisms, and cardiac regeneration. Highlights included two keynote lectures on cardiac genetics and development. In keeping with an established, decades-long tradition, the conference is a well-attended event, marking significant engagement in the latest cardiovascular research. The next appointment will be in Granada, Spain, 15–17 October 2025.

Principles of Outpatient Care of Patients With Heart Failure

These guidelines combine the key provisions for the management of patients with chronic heart failure (CHF) at the outpatient stage based on current data from clinical studies, new 2024 clinical guidelines of the Russian Society of Cardiology for the management of CHF patients, and the provisions of the current order of the Ministry of Health of the Russian Federation on the procedure for conducting dispensary observation. CHF is a progressive disease characterized by a high risk of death, rehospitalizations, and disability. Reducing the risk of CHF decompensation and improving the prognosis is possible only with regular monitoring of the patient's condition and timely correction of therapy. The priority task of the outpatient unit is to expand the coverage of dispensary follow-up of CHF patients, preventive counseling, and telemedicine monitoring for timely identification of the patients at a high risk of CHF progression, improving their quality of life, and prolonging their life duration.

Incidence and prognosis of first-ever intracerebral hemorrhage on antiplatelet therapy over 10 years in a population-based stroke registry

The use of antiplatelet therapy (APT) is prevalent among the general population, sometimes without clear indications. We provided updated figures on the incidence and prognosis of first-ever intracerebral hemorrhage occurring on APT (APT-ICH) over 10 years in a population-based stroke registry and investigated the rates of inappropriate APT prescription. We included all cases of first-ever ICH not on anticoagulants from January 2011 to December 2020 in the district of L’Aquila (Southern Italy). Indication to APT was adjudicated according to 2021 European Society of Cardiology (ESC) guidelines for cardiovascular prevention. We included 606 first-ever ICHs, of whom 251 (41.4%) were APT-related. One-hundred-forty-two APT-ICHs (56.6%) occurred in patients without clear indications to APT. While the incidence of non-APT-ICH decreased over time, the incidence of APT-ICH was stable. APT-ICH showed higher 30-day and 1-year case-fatality rates versus non-APT-ICH (44.7% versus 25.6%, 50.6% versus 34.4%; p < 0.001). APT intake was independently associated with higher 30-day case-fatality (HR 1.51, 95%CI 1.03–2.14; p = 0.023). Our findings suggest that APT-ICH exhibits sustained incidence over time and elevated mortality. Urgent initiatives are needed to enhance adherence to established guidelines for APT use. This effort has the potential to mitigate the risk of ICH and to reduce the associated mortality.

Endocarditis: updates for clinical practice

Infective endocarditis, or inflammation of the endocardium, is a relatively rare condition with a reported incidence of between 3–10 cases per 100000. However, it is associated with poor patient outcomes including increased morbidity and mortality, increased length of hospital stay, and reduced quality of life, resulting in a significant burden on the healthcare system. Nurses and allied health professionals must be familiar with contemporary evidence-based guidelines to optimise patient care and improve outcomes. This article provides an overview of the European Society of Cardiology 2023 guidelines and recommendations for the management of patients with endocarditis.

European Society of Cardiology (ESC) guidelines on atrial fibrillation 2024 : What is new and what is important?

The 2024 guidelines of the European Society of Cardiology (ESC) on atrial fibrillation (AF) present current and comprehensive recommendations for the diagnosis, prevention and treatment of AF. They are based on the AF-CARE treatment pathway, which includes modification of cardiovascular risk factors, stroke prevention, symptom management and continuous re-evaluation. Accordingly, all patients with newly diagnosed AF should undergo transthoracic echocardiography. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended for the treatment of heart failure across all clinical and echocardiographic levels of left ventricular ejection fraction (LVEF). The CHA2DS2-VASc score has been simplified to the CHA2DS2-VA score for the risk assessment of thromboembolism. For rate or rhythm control pharmacotherapy with beta-blockers, digitalis, amiodarone and flecainide are still the most important drugs. Pulmonary vein isolation is now also recommended as afirst-line treatment for paroxysmal AF. Re-evaluation of risk factors and treatment of comorbidities is also emphasized. Overall the guidelines represent a further development and update based on recent studies. They remain practical and provide clear and detailed recommendations for action that are globally recognized in the clinical practice.

Failure of LDL-C goals achievement and underuse of lipid-lowering therapies in patients at high and very high cardiovascular risk: Spanish subset from the European SANTORINI study

IntroductionThere are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk. MethodsSANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1,018 Spanish participants, were separately analyzed and were put into perspective with the European cohort without Spanish participants. ResultsAccording to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT. ConclusionsBaseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting. ClinicalTrials.gov Identifier: NCT04271280.

What is new in the management of peripheral arterial occlusive disease and diseases of the aorta? : Highlights of the ESC guidelines 2024

The European Society of Cardiology (ESC) guidelines on peripheral arterial disease (PAD) and diseases of the aorta published in September 2024 for the first time combine recommendations for both diseases in a joint guideline document. The consolidation of PAD and aorta guidelines follows aholistic approach, which underlines the entirety of the arterial vascular system. This aim is underlined by a specifically introduced recommendation to take the entirety of the circulatory system into account in patients with vascular diseases. The focus in the current ESC guideline document is on amultidisciplinary, patient-centered management of PAD and diseases of the aorta, whereby the prevention and follow-up of patients after therapeutic interventions are emphasized. In PAD the document highlights exercise training and the procedure for patients with chronic wounds as well as risk stratification and hereditary diseases of the aorta.

Preoperative risk prediction models for noncardiac surgery patients : Interpret and use risk scores correctly

Risk prediction models are an established component of the preoperative evaluation. In its guidelines the European Society for Cardiology proposes several risk scores but the benefit of these is mostly unclear for clinicians. This article describes the individual steps in the preparation of a valid prediction model with a focus on the parameters, discrimination, calibration and external validation. The clinical benefits of the risk scores proposed in the guidelines with respect to these parameters was investigated. All proposed risk scores appear to show a good discrimination in the validation cohorts. Only a few reliable data for a good calibration could be compiled. The external validity of the individual models is unclear. The general benefit of the risk scores cannot be recommended as data for calibration or discrimination in external cohorts are lacking. A precise estimation of the risk cannot be expected.

Impact of Updated Invasive Right Ventricular and Pulmonary Hemodynamics on Long-Term Outcomes in Patients With Mitral Valve Transcatheter Edge-to-Edge Repair

Right-sided cardiac catheterization (RHC) is selectively recommended in mitral valve transcatheter edge-to-edge (M-TEER) workup because right ventricle (RV) hemodynamic parameters predict adverse outcomes. This study examines the impact of RV hemodynamics and the prognostic value of the 2022 European Society of Cardiology (ESC) pulmonary hypertension definitions on outcomes after M-TEER. Of 152 patients treated with M-TEER for symptomatic severe mitral regurgitation (MR) between December 2014 and February 2024 at our tertiary center, 71 underwent elective RHC before the procedure. The primary outcomes assessed were all-cause mortality and a composite of heart failure hospitalization and death at the longest available follow-up. In a cohort of 152 mostly male patients (64%) with a median age of 79 years who were treated for symptomatic severe MR, 71 underwent elective RHC. The causes were categorized as degenerative (47%), functional ventricular (41%), and atrial (12%). Pulmonary hypertension (PH) was common, with 74% showing mean pulmonary artery pressure (mPAP) >20 mm Hg and 39% with pulmonary vascular resistance (PVR) >2 Wood Units. Success rates were high, with technical, device, and procedural success at 97%, 88%, and 84%, respectively. At a median follow-up of 681 days, all-cause mortality was 50%, and the composite outcome (death or heart failure hospitalizations) occurred in 61%. Key hemodynamic parameters, including mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio, were independently linked to mortality risk. Kaplan-Meier analysis found significant associations with mPAP >20 mm Hg and pulmonary capillary wedge pressure >15 mm Hg for long-term mortality, whereas the 2022 ESC PH thresholds showed greater sensitivity, correlating with increased mortality risk. In patients with severe MR who undergo M-TEER, most RV invasive hemodynamic parameters are linked to adverse long-term outcomes, with mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio identified as independent predictors of mortality. Despite the study's limited sample size, the updated ESC PH definitions enhance prognostic assessment.

National health expenditure per capita is associated with CRT implantation practice: findings from the ESC CRT Survey II with 11 088 patients.

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. This treatment receives class IA recommendations in European Society of Cardiology (ESC) guidelines. However, despite these strong recommendations, CRT implantation practice varies greatly in Europe. The purpose of the sub-analysis of CRT Survey II data was to describe how countries' health per capita expenditure affects CRT implantation practice. Between 2015 and 2016, two ESC associations, European Heart Rhythm Association and Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11 088 patients in 42 ESC member states. We analysed CRT patient selection and guideline adherence in those countries according to high or low health expenditure per capita. There were 21 high health expenditure countries (n=6844 patients) and 21 (n=3852) with low health expenditure. The countries with the lowest health expenditure were more likely to implant CRT in patients who had strong guideline recommendations for implantation, younger patients and those recently hospitalized for HF or with symptomatic HF (67% vs. 58%, P<0.001). The ratio of CRT-Pacemaker (CRT-P) to CRT-Defibrillator (CRT-D) was similar in both spending groups, as was the percentage of CRT implantation in women. CRT Survey II has demonstrated a non-uniform delivery of healthcare. Countries with low health expenditure per capita appear to be reserving CRT therapy for younger patients, those with class IA indication and patients with more severe symptoms of heart failure.

Alternative LDL Cholesterol–Lowering Strategy vs High-Intensity Statins in Atherosclerotic Cardiovascular Disease

In patients with atherosclerotic cardiovascular disease (ASCVD), intensive lowering of low-density lipoprotein (LDL) cholesterol levels with high-intensity statins is generally recommended. However, alternative approaches considering statin-related adverse effects and intolerance are needed. To compare the long-term efficacy and safety of an alternative LDL cholesterol-lowering strategy vs high-intensity statin strategy in patients with ASCVD in randomized clinical trials. PubMed, Embase, and other websites (ClinicalTrials.gov, European Society of Cardiology, tctMD) were systematically searched from inception to April 19, 2024. Randomized clinical trials comparing an alternative LDL cholesterol-lowering strategy vs a high-intensity statin strategy in patients with ASCVD, with presence of cardiovascular events as end points. Individual patient data were obtained from randomized clinical trials that met the prespecified eligibility criteria: RACING (Randomized Comparison of Efficacy and Safety of Lipid-Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein Cholesterol-Targeting Statin Therapy vs Intensity-Based Statin Therapy in Patients With Coronary Artery Disease). The moderate-intensity statin with ezetimibe combination therapy in the RACING trial and the treat-to-target strategy in the LODESTAR trial were classified as alternative LDL cholesterol-lowering strategies. The primary analysis was based on a 1-stage approach. The primary end point was a 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. The secondary end points comprised clinical efficacy and safety end points. Individual patient data from 2 trials including 8180 patients with ASCVD (mean [SD] age, 64.5 [9.8] years; 2182 [26.7%] female; 5998 male [73.3%]) were analyzed. The rate of the primary end point did not differ between the alternative strategy and high-intensity statin strategy groups (7.5% [304 of 4094] vs 7.7% [310 of 4086]; hazard ratio, 0.98; 95% CI, 0.84-1.15; P = .82). The mean (SD) LDL cholesterol level during treatment was 64.8 (19.0) mg/dL in the alternative strategy group and 68.5 (20.7) mg/dL in the high-intensity statin strategy group (P < .001). The alternative strategy group had a lower rate of new-onset diabetes (10.2% [271 of 2658] vs 11.9% [316 of 2656]; P = .047), initiation of antidiabetic medication for new-onset diabetes (6.5% [173 of 2658] vs 8.2% [217 of 2656]; P = .02), and intolerance-related discontinuation or dose reduction of assigned therapy (4.0% [163 of 4094] vs 6.7% [273 of 4086]; P < .001). Results of this systematic review and individual patient data meta-analysis suggest that compared with a high-intensity statin strategy, the alternative LDL cholesterol-lowering strategy demonstrated comparable efficacy regarding 3-year death or cardiovascular events in patients with ASCVD, with an associated reduction in LDL cholesterol levels and risk for new-onset diabetes and intolerance. PROSPERO CRD42024532550.

High low-density lipoprotein cholesterol levels in people with HIV by individual cardiovascular risk: A retrospective observational study

BackgroundPeople with HIV (PWH) are at increased risk of atherosclerotic cardiovascular disease (ASCVD). Lowering low-density lipoprotein cholesterol (LDL-C) is central of cardiovascular disease prevention. The aim of this study was to assess the prevalence, treatment, and control of high LDL-C levels as assessed on the basis of the ASCVD risk profiles indicated by European Society of Cardiology (ESC) guidelines of a cohort of PWH in order to evaluate the state of LDL-C management in current clinical practice. MethodsWe retrospectively assessed the prevalence, treatment, and control of high LDL-C levels in a cohort of PWH aged ≥40 years who accessed our HIV outpatient clinic between 1 March 2022 and 31 March 2023. Their 10-year ASCVD risk was calculated on the basis of their age and co-morbidities as recommended by guidelines. High LDL-C levels were defined as those above the “step two” target of their specific ASCVD risk category. ResultsAmong the 1404 assessed PWH, who were prevalently male (74.5 %) and Caucasian (85.6 %), and had a median age of 56 years (interquartile range [IQR] 49–61), 295 (21 %) were at very high risk (VHR), 634 (45.2 %) at high-risk (HR), and 348 (24.8 %) not at HR. The overall median LDL-C level was 116 mg/dL (IQR 96–141). Five hundred and sixteen (37 %) were undergoing lipid lowering treatment (LLT), and 650 (46.3 %) failed to achieve any step of their target LDL-C levels. ConclusionsDespite the high prevalence of PWH at VHR/HR for ASCVD, LDL-C levels were poorly controlled and LLT was greatly under used.

What is proven in the treatment of lipid disorders?

Cardiovascular diseases are still the leading global cause of mortality. Modifiable cardiovascular risk factors have been well-defined for many years and are amenable to multimodal treatment. The scope of pharmaceutical interventions targeting atherogenic lipoproteins in general and low-density lipoprotein (LDL)-cholesterol concentrations in particular, has significantly broadened over the last years, leading to an intensification of appropriate treatment targets, which are not sufficiently achieved in the clinical routine. Current prevention guidelines issued by the European Society for Cardiology (ESC) define patient cohorts according to their individual cardiovascular risk, which results in arisk-adapted lipid-lowering treatment. The aim is to avoid overtreatment of patients with a low or moderate risk and undertreatment of patients with a high or very high risk. In addition to secondary prevention in patients with an already established cardiovascular disease, primary prevention uses age-adapted risk stratification algorithms to assess the 10-year risk, e.g., systematic coronary risk evaluation 2 (SCORE2), SCORE2-older persons (SCORE2-OP) and the lifetime risk, e.g., lifetime-perspective cardiovascular disease model (LIFE-CVD) as the foundation for therapeutic decision making. Special patient groups with known elevated cardiovascular risk (familial hypercholesterolemia, diabetes mellitus, chronic kidney disease) are stratified by incorporating disease-specific parameters and are treated according to defined lipid-lowering targets.

Definitions of clinical study outcome measures for cardiovascular diseases: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart).

Standardized definitions for outcome measures in randomized clinical trials and observational studies are essential for robust and valid evaluation of medical products, interventions, care, and outcomes. The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology aimed to create international data standards for cardiovascular clinical study outcome measures. The EuroHeart methods for data standard development were used. From a Global Cardiovascular Outcomes Consortium of 82 experts, five Working Groups were formed to identify and define key outcome measures for: cardiovascular disease (generic outcomes), acute coronary syndrome and percutaneous coronary intervention (ACS/PCI), atrial fibrillation (AF), heart failure (HF) and transcatheter aortic valve implantation (TAVI). A systematic review of the literature informed a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition and categorized the variable as mandatory (Level 1) or optional (Level 2) based on its clinical importance and feasibility. Across the five domains, 24 Level 1 (generic: 5, ACS/PCI: 8, AF: 2; HF: 5, TAVI: 4) and 48 Level 2 (generic: 18, ACS-PCI: 7, AF: 6, HF: 2, TAVI: 15) outcome measures were defined. Internationally derived and endorsed definitions for outcome measures for a range of common cardiovascular diseases and interventions are presented. These may be used for data alignment to enable high-quality observational and randomized clinical research, audit, and quality improvement for patient benefit.