Disease Prevention In Clinical Practice Research Articles

Improvement in achievement of lipid targets in France: Comparison of data from coronary patients in the DYSIS and DYSIS II studies

Hyperlipidaemia is a major contributor to the development of coronary heart disease (CHD), with a direct correlation between low-density lipoprotein cholesterol (LDL-C) and all-cause death [ 1 Wilson P.W. D'Agostino R.B. Levy D. Belanger A.M. Silbershatz H. Kannel W.B. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97: 1837-1847 Crossref PubMed Scopus (7417) Google Scholar , 2 Stamler J. Daviglus M.L. Garside D.B. Dyer A.R. Greenland P. Neaton J.D. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000; 284: 311-318 Crossref PubMed Scopus (460) Google Scholar ]. The cross-sectional, observational Dyslipidemia International Study (DYSIS) study [ 3 Gitt A.K. Drexel H. Feely J. Ferrieres J. Gonzalez-Juanatey J.R. Thomsen K.K. et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur. J. Prev. Cardiol. 2012; 19: 221-230 Crossref PubMed Scopus (123) Google Scholar , 4 Gitt A.K. Lautsch D. Ambegaonkar B. Horack M. Ferrières J. Persistent high distance to recommended LDL-cholesterol-targets despite chronic statin treatment: results of DYSIS. J. Am. Coll. Cardiol. 2016; 67: 1934 Crossref Google Scholar ] was conducted between 2008 and 2012 in 26 countries. The study involved 57,885 patients aged ≥45 years treated in primary or secondary care and who had been on statin treatment for at least 3 months. In a previous examination of the first 12 countries included in DYSIS [ [3] Gitt A.K. Drexel H. Feely J. Ferrieres J. Gonzalez-Juanatey J.R. Thomsen K.K. et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur. J. Prev. Cardiol. 2012; 19: 221-230 Crossref PubMed Scopus (123) Google Scholar ], half of the patients did not achieve their target LDL-C goals, as defined by the 2007 European Society of Cardiology (ESC) guidelines [ [5] Graham I. Atar D. Borch-Johnsen K. Boysen G. Burell G. Cifkova R. et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur. Heart J. 2007; 28: 2375-2414 Crossref PubMed Scopus (1293) Google Scholar ]. Among the French cohort in DYSIS, 37.2% of the patients [ [6] Agence Française de Sécurité Sanitaire des Produits de Santé Prise en charge therapeutique du patient dyslipidémique. in: Recommandations. 2005 Google Scholar ] met the French recommendations on LDL-C control [ [7] Ferrieres J. Berard E. Crisan O. Bongard V. Residual dyslipidaemia after statin treatment in France: prevalence and risk distribution. Arch. Cardiovasc. Dis. 2010; 103: 302-309 Crossref PubMed Scopus (13) Google Scholar ]. These data from DYSIS demonstrate a substantial gap between guideline recommendations and achievement of LDL-C targets in practice.

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

CardioPulse ArticlesThe 2016 ESC European Guidelines for Cardiovascular Disease Prevention in Clinical Practice: The VI Joint Task ForceBook ReviewThe PCR-EAPCI Percutaneous Interventional Cardiovascular Medicine textbookWhat's new in coronary interventions? Changes in conceptEACPR country of the month initiative: France

CardioPulse ArticlesThe 2016 ESC European Guidelines for Cardiovascular Disease Prevention in Clinical Practice: The VI Joint Task Force<i>Book Review</i>The PCR-EAPCI Percutaneous Interventional Cardiovascular Medicine textbookWhat's new in coronary interventions? Changes in conceptEACPR country of the month initiative: France

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

ABI : ankle–brachial (blood pressure) index ABPM : ambulatory blood pressure monitoring ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE-I : angiotensin-converting enzyme inhibitor ACS : acute coronary syndromes ADVANCE : Action in Diabetes and Vascular disease: PreterAx

Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke.

BackgroundControl of modifiable cardiovascular disease (CVD) risk factors has substantially reduced CVD mortality, but risk factor levels in populations may change and need continuous monitoring. This study aims to provide current estimates of the prevalence of these risk factors in Germany according to sex and history of coronary heart disease (CHD) or stroke.MethodsThe analyses were based on data from the German Health Interview and Examination Survey for Adults (DEGS1; age 40–79 years, n = 5101), which is a cross-sectional population-based examination survey. CVD risk factors were defined according to recommendations in the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2012.ResultsThe mean age was 57 years and 52 % were female; 493 participants had prior CHD and 163 participants a prior stroke. The overall prevalence of behavioural risk factors ranged from 17.9 % for high risk alcohol consumption to 90 % for low vegetable intake. Blood pressure ≥ 140/90 mmHg was found in 21 % and 69 % had total cholesterol ≥ 5.0 mmol/l. Only 16 % met the targets for five behavioural factors combined (smoking, physical activity, fruit intake, alcohol intake and obesity), 13 % of those with and 16 % of those without CHD or stroke. The prevalences of most behavioural risk factors were higher among men compared to women.ConclusionsThere is a high prevention potential from modifiable cardiovascular risk factors in the general population aged 40–79 years in Germany and among those with prior CHD or stroke. Risk factors are often co-occurring, are interrelated and require combined educational, behavioral, medical and policy approaches.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1929-5) contains supplementary material, which is available to authorized users.

Should ethnicity be included in cardiovascular risk stratification?

Assessment of patients’ individual cardiovascular risk is common in routine clinical practice. However, the traditional risk factors to stratify risk are based on population estimates and may not directly apply to the individual patient. Patients with a high calculated cardiovascular risk may not suffer an event and vice versa. The Framingham score estimates the 10-year risk of a cardiovascular event based on several clinical and laboratory variables. Ethnicity is known to be related to risk of cardiovascular disease (CVD), but is not included in most risk scores. Also, differences in traditional risk factors do not fully explain the racial differences in CVD risk. To improve the ability to predict individual events, new biomarkers and imaging methods are currently being evaluated. Imaging for atherosclerosis using coronary artery calcium (CAC) and carotid intima media thickness (CIMT) may offer a valuable tool in this approach and is recommended (class IIa) in asymptomatic adults at moderate risk in the current ESC guidelines on cardiovascular disease prevention in clinical practice [1]. Multiple studies have evaluated the association of CAC scores with risk for adverse coronary events, but only a few studies have distinguished between subjects from different ethnic groups. In this issue of the Netherlands Heart Journal, Erqou et al. [2] assessed the racial differences in the burden of CAC and CIMT between Blacks and Whites using data from an on-going community-based prospective cohort study (heart SCORE). The authors conclude that Black race is independently associated with greater CIMT but less CAC than White race, also after adjustment for traditional risk factors. A correlation between ethnicity, CAC, and events was previously reported in the Multi-Ethnic Study of Atherosclerosis (MESA), a large prospective, population-based study of samples from six urban communities [3, 4]. It was reported that the prevalence and extent of coronary calcification differ substantially among ethnic groups [3]. In the MESA study, CAC was measured to predict coronary events in four major ethnic groups [4]. After a median follow-up of nearly 4 years, a strong correlation was found between calcium scores and coronary risk. Adjusting for standard risk factors, a doubling of the CAC score was associated with a 25 % increase in the risk for a major event. However, the association was independent of ethnicity. Unfortunately, Erqou et al. [2] do not present data on cardiovascular events to relate their results to future cardiovascular events. The novelty of the work by Erqou et al. lies in the additional biochemical marker analysis assessment. Six markers were analysed, i.e. small-dense low-density lipoprotein (sdLDL), high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule 1 (sICAM-1), CD40 ligand (CD40L), and endostatin. Small-dense LDL was positively associated with increased CIMT (similar association among Blacks and Whites) and IL-6 concentration was positively associated with higher CAC among Blacks (trend in Whites). IL-6 is a promising biomarker for linking inflammation to future vascular events [5]. As the authors suggest, the low CAC and high IL-6 in the Black population might reflect less calcified coronary lesions and a higher inflammatory state and therefore a patient at risk for future cardiac events. This could, hypothetically, be associated with the higher risk of CVD in Blacks. Further studies are needed to confirm such a difference in atherosclerotic pathophysiology between ethnic groups. In conclusion, this study confirms the earlier findings that CAC and CIMT values differ among ethnic groups and points to specific biomarkers that might be used to create race-specific algorithms for risk stratification. Hopefully, in the near future, we may further determine how these tests can be used to achieve better outcomes for individual patients.

Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

Introduction and objectivesThere are no nationwide, population-based studies in Spain assessing overall cardiovascular risk. We aimed to describe cardiovascular risk and achievement of treatment goals following the 2012 European Guidelines on cardiovascular disease prevention strategy. We also investigated clinical characteristics (non-classical risk factors) associated with moderate risk. MethodsParticipants (n=2310, 58% women) aged 40 to 65 years from a national population-based study (Di@bet.es Study) were identified. First, a priori high/very-high risk individuals were identified. Next, total cardiovascular risk (Systematic Coronary Risk Evaluation equation including high-density lipoprotein cholesterol) was used to assess risk of a priori non-high risk individuals. Variables independently associated with moderate versus low-risk were investigated by multiple logistic regression analysis. ResultsAge-and-sex standardized (direct method) percentages of high/very-high, moderate, and low-risk were 22.8%, 43.5%, and 33.7%, respectively. Most men were at moderate (56.2%), while 55.4% of women were at low risk. Low-density lipoprotein cholesterol (< 70,<100, < 115mg/dL) and blood pressure (<140/90mmHg) goals for very-high, high and moderate risk were met in 15%, 26% and 46%, and 77%, 68% and 85% of the individuals, respectively. Body mass index, high triglycerides concentrations, diastolic blood pressure, and low Mediterranean diet adherence (in women) were independently associated with moderate (versus low) risk. ConclusionsCardiovascular risk in Spain is mainly moderate in men and low in women. Achievement of treatment goals in high-risk individuals should be improved. The prevalence of non-classical cardiovascular risk factors is elevated in subjects at moderate risk, an important aspect to consider in a population-based strategy to decrease cardiovascular disease in the most prevalent group.

SAT0445 Risk of Cardiovascular Disease in Patients with Osteoarthritis: Results from the Must-Heart Study

BackgroundControversies exist regarding whether patients with osteoarthritis (OA) have an increased risk of cardiovascular (CV) disease.ObjectivesOur aim was to evaluate the CV risk in a population-based OA cohort.MethodsThe Musculoskeletal pain...

SAT0381 On the Hunt for Cardiovascular Risk Factors and Disease in Patients with Psoriatic Arthritis – Results from the Norwegian Hunt Study

BackgroundControversies exist regarding increased risk of cardiovascular (CV) disease in patients with psoriatic arthritis (PsA).ObjectivesTo compare the presence of CV risk factors and disease in patients with PsA and the...

Intervention for cardiovascular risk factors decreases adipocyte fatty acid-binding protein levels in males — a pilot study

Abstract Cardiovascular disease (CVD) remains the leading cause of mortality in developed countries. According to the 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, family history is a cornerstone for risk stratification of CVD. First-degree relatives are persons in whom CVD should be assessed and targeted intervention should be performed. The aims of this pilot study were (i) to determine risk factors (RFs) for cardiovascular disease (CVD) in a group of first-degree relatives of patients with CVD at baseline and after 1 year, (ii) to measure adipocyte fatty acid-binding protein (A-FABP) levels as a potential connecting link between metabolic disease and atherosclerosis, and (iii) to determine the impact of targeted intervention on these parameters. The study comprised 62 asymptomatic subjects (41 males; mean age of 53.8±8.3 years). Preventive examinations and interventions were carried out at baseline and at 1-year follow-up to assess RFs and evaluate A-FABP levels. At 1 year, males had significantly lower levels of cholesterol (median 5.18 vs 4.67, p=0.005), HDL (median 1.24 vs 1.14, p=0.021), LDL (median 3.08 vs 2.46, p=0.021), ApoB (median 0.99 vs 0.82, p=0.012) and A-FABP (median 19.84 vs 16.73, p = 0.015). In females after 1 year, only significantly lower levels of fibrinogen (median 3.10 vs 2.79, p=0.043) were found. All subjects were clinically examined or contacted by phone after a mean of 36.7 months (range, 11–55). Over that time, no serious complications were noted. In males, intervention for RFs leads to lower levels of A-FABP as a potential RF linking metabolic syndrome to atherosclerosis.

Comment to the position paper on global recommendations for the management of dyslipidemia developed by the International Atherosclerosis Society (IAS)

In a previous issue of Atherosclerosis a summary of the position paper on Global Recommendations for the Management of Dyslipidemia, developed by the International Atherosclerosis Society (IAS) was published. The European perspective on the treatment of dyslipidaemia was recently published in the guidelines on dyslipidaemia developed by EAS and ESC (EAS/ESC Guidelines for the Treatment of Dyslipidaemia) [1], followed by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice [2].

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)

Psychosocial distress under pressure

In the current issue of the Netherlands Heart Journal, Ringoir and colleagues reportaninteresting observation: in a cohort of 605 elderly (60–85 years) primary care patients, with hypertension but without heart failure or current treatment by a cardiologist, no significant association between symptoms of psychological distress (depression, anxiety and type D personality) and systolic blood pressure>160 mmHg could be demonstrated [1]. Possibly, this study is underpowered and a larger study group would have shown a significant association for type D personality (the reported adjusted odds ratio for type D personality was 1.563 with a confidence interval of 0.805– 3.038). Possibly, this study suffers from selection bias (only 68 % of the invited patients agreed to participate, and personality plays a role in the decision to participate in research studies or not [2, 3]. These, and other limitations reported by the authors, make it difficult to draw definite conclusions and leave us with question marks to be added to the multiple existing question marks regarding the role of personality characteristics and psychosocial factors in the development and progression of cardiovascular disease, and the options for successful interventioninthisrespect.AtvariousinstancesintheIntroduction and the Discussion, the authors position their rationale and findings amidst this ongoing discussion. It is, indeed, striking that the published odds ratios of the association between type D personality and mortality/nonfatal myocardial infarction have decreased over time [4], a result that should most likely be ascribed to methodological differences between earlier and later studies. The most recent European Society of Cardiology guidelines on cardiovascular disease prevention in clinical practice [5] endorse on pages 1653–1655 and 1671–1672 the view that psychosocial factors, including type D personality, contribute both to the risk of developing cardiovascular disease and to the worsening of the clinical course and prognosis of cardiovascular disease, amongst others because these factors act as barriers to treatment adherence and efforts to improve lifestyle, as well as to promoting health and wellbeing in patients and populations. On the other hand, effects of intervention with these psychosocial factors are as yet not really clear; e.g., the guidelines conclude that evidence that treatment of clinically significant depression and anxiety will improve cardiac endpoints is inconclusive. Beyond any doubt, further research, preferably by multidisciplinary research groups, is needed to make clear if and to what extent psychosocial intervention could help to decrease the burden of cardiovascular disease. Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

CSI at global forum on cardiovascular disease prevention in clinical practice at ESC-EuroPrevent 2013

Cardiovascular diseases (CVD) remain the grim reaper's primary calling card.1 Mortality and morbidity from CVDs, both coronary heart disease (CHD) and stroke, have declined in most high income countries and presently the largest burden has shifted to middle and low income countries.2 Indeed, India and China account for more cases of CVD than all developed countries put together.1 Unique characteristics of CVD in low and middle income countries such as India are premature onset, high mortality, increasing burden and regional variations.3 The good news is that most premature CVD can be prevented and controlled by a combination of changes in policy, healthcare programs, process implementation, physician education and task shifting, practice paradigms, population-wide interventions, primary prevention, better patient management and patient empowerment for risk factors and disease prevention and management (Table 1). Table 1 Nine P's of prevention.

AB0430 What is the role of ambulatory blood pressure monitoring in sle?

BackgroundPatients with systemic lupus erythematosus (SLE) are at increased risk for the development of atherosclerotic cardiovascular disease (CVD). Hypertension (HT) which is frequently seen in SLE is a major risk...

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

Guidelines, position papers and critical reviews: differences and similarities

In the European Journal of Preventive Cardiology more and more position papers and expert consensus papers are published as well as critical reviews. The same is true for the other journals of the European Society of Cardiology (ESC) family, particularly for the European Heart Journal, where all ESC Guidelines are published. A great number of guidelines, position papers and critical reviews have been issued in other different scientific medical journals around the world as well, particularly during the last decades. When searching PubMed under ‘guidelines’ one can find 221,633 papers with the intensity of publication varying from only four in the year 1960 up to 17,625 in the year 2011. One can find also 91,016 ‘critical reviews’, 11,976 ‘position papers’ and 4287 ‘expert consensus papers’. However, many experts are not quite sure what the differences are between these different types of manuscript. This editorial is aimed at providing a brief insight into their differences and similarities. Although focusing only on publications developed/written by the ESC and its entities such as the European Association for Cardiovascular Prevention and Rehabilitation (EACPR), most of this editorial can be applied to the publications of all other scientific societies in medicine as well. Guidelines are official publications of the ESC which are produced by the task forces supervised, reviewed and approved by the ESC Committee for Practice Guidelines (CPG). ESC entities (Associations, Working Groups, Councils, etc.) do not produce their own guidelines but can produce position papers and expert consensus documents in the name of their entity or group of authors. Guidelines are produced to present all the relevant and best available up-todate evidence on a particular broad clinical issue with the aim to help clinicians in their everyday clinical practice when they have to weigh the benefits and risks of a diagnostic and/or therapeutic procedure. According to this they provide well-balanced information reflecting established evidence-based knowledge on a specific subject and systematically developed recommendations for diagnosis and treatment for practitioners. However, it has to be stressed that applying them in everyday practice always requires careful judgement of individual cases. Considering all this, guidelines are also aimed to be used to develop standards to assess the best clinical practice. The methodological standards for issuing good quality and trustworthy guidelines were well defined more than a decade ago and ESC Guidelines follow the high quality criteria for the development of guidelines which can be found at www.escardio.org/knowledge/ guidelines/rules. Since the guidelines should not only represent the views of one or two specific groups of experts in selected topics, the task forces have to be composed of a diverse expertise to represent the multidisciplinary views and give an objective evaluation of the particular broad subject at hand. The guidelines’ recommendations must be graded according to four different classes (I, IIa, IIb and III) and linked to their levels of evidence (A, B and C), but some guidelines might have in addition also another type of grading such as GRADE (strong or weak recommendation), which could be more suitable for a particular topic and which has the advantage of distinguishing quality of evidence and strength of recommendation. For instance, this latter type of grading was used in the recently published 2012 joint Guidelines on cardiovascular disease prevention in clinical practice, illustrating that strong evidence does not automatically lead to a strong recommendation. Although the implementation of the guidelines’ recommendations should be an integral part of the guidelines’ development process, the adherence to guidelines is often far from optimal due to many barriers which have not substantially changed during the last decade. Some of the ESC Guidelines are produced solely by the ESC and some are produced in partnership with another societies, such as the Guidelines for

'European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)' The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR). [Eur Heart

'European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)' The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention &amp; Rehabilitation (EACPR). [Eur Heart

Arab–Jewish differences in attending cardiac rehabilitation programs following acute coronary syndrome

Intensive efforts to change lifestyle and to manage classical risk factors for coronary heart disease (CHD) via formal programs of cardiac prevention and rehabilitation (CPRP) are strongly recommended as an integral part of proper follow-up care after an acute coronary syndrome (ACS) [ [1] Perk J. De Backer G. Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2012; ([Published online ahead of print 3 May 2012])https://doi.org/10.1093/eurheartj/ehs092 Crossref Scopus (3060) Google Scholar ]. Despite these recommendations, low participation rates in CPRP prevail among ethnic minorities worldwide [ 2 Valencia H.E. Savage P.D. Ades P.A. Cardiac rehabilitation participation in underserved populations. Minorities, low socioeconomic, and rural residents. J Cardiopulm Rehabil Prev. 2011; 31: 203-210 Crossref PubMed Scopus (63) Google Scholar , 3 Suaya J.A. Shepard D.S. Normand S.L. Ades P.A. Prottas J. Stason W.B. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007; 116: 1653-1662 Crossref PubMed Scopus (599) Google Scholar , 4 Thompson D.R. Clark A.M. Cardiac rehabilitation: into the future. Heart. 2009; 95: 1897-1900 Crossref PubMed Scopus (53) Google Scholar ]. Studies carried out in Israel have shown substantially higher CHD incidence, case fatality and mortality in the Arab versus the Jewish population [ 5 Kark J.D. Fink R. Adler B. Goldberger N. Goldman S. The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem. Int J Epidemiol. 2006; 35: 448-457 Crossref PubMed Scopus (41) Google Scholar , 6 Kark J.D. Gordon E.S. Haklai Z. Coronary heart disease mortality among Arab and Jewish residents of Jerusalem. Lancet. 2000; 356: 1410-1411 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar ]. Our objective was to examine whether an ethnic difference, comparing Arab and Jewish patients, exists in participation in CPRP after ACS within a context that strongly encourages such preventive activity, and under universal national health insurance that includes coverage for cardiac rehabilitation.

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).