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Document Reviewers: Guy De Backer (CPG Review Coordinator) (Belgium), Vera Regitz-Zagrosek (CPG Review Coordinator) (Germany), Anne Hege Aamodt6 (Norway), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Christian Albus11 (Germany), Riccardo Asteggiano (Italy), Magnus B€ack (Sweden), Michael A. Borger (Germany), Carlos Brotons13 (Spain), Jelena Celutkien _e (Lithuania), Renata Cifkova (Czech Republic), Maja Cikes (Croatia), Francesco Cosentino (Italy), Nikolaos Dagres (Germany), Tine De Backer (Belgium), Dirk De Bacquer (Belgium), Victoria Delgado (Netherlands), Hester Den Ruijter (Netherlands), Paul Dendale (Belgium), Heinz Drexel (Austria), Volkmar Falk (Germany), Laurent Fauchier (France), Brian A. Ference (United Kingdom), Jean Ferrie`res (France), Marc Ferrini (France), Miles Fisher1 (United Kingdom), Danilo Fliser4 (Germany), Zlatko Fras (Slovenia), Dan Gaita3 (Romania), Simona Giampaoli (Italy), Stephan Gielen (Germany), Ian Graham (Ireland), Catriona Jennings (Ireland), Torben Jorgensen (Denmark), Alexandra Kautzky-Willer12 (Austria), Maryam Kavousi (Netherlands), Wolfgang Koenig (Germany), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ulf Landmesser (Germany), Madalena Lettino (Italy), Basil S. Lewis (Israel), Ales Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Konstantinos Makrilakis9 (Greece), Giuseppe Mancia5 (Italy), Pedro Marques-Vidal (Switzerland), John William McEvoy (Ireland), Paul McGreavy (United Kingdom), Bela Merkely (Hungary), Lis Neubeck (United Kingdom), Jens Cosedis Nielsen (Denmark), Joep Perk (Sweden), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Massimo Piepoli (Italy), Nana Goar Pogosova (Russia), Eva Irene Bossano Prescott (Denmark), Kausik K. Ray2 (United Kingdom), Zeljko Reiner (Croatia), Dimitrios J. Richter (Greece), Lars Ryde ́n (Sweden), Evgeny Shlyakhto (Russia), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Isabella Sudano (Switzerland), Monica Tiberi7,10 (Italy), Rhian M. Touyz (United Kingdom), Andrea Ungar8 (Italy), W.M. Monique Verschuren (Netherlands), Olov Wiklund (Sweden), David Wood (United Kingdom/Ireland), Jose Luis Zamorano (Spain)

All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines

Collaborating and endorsing societies: 1European Association for the Study of Diabetes (EASD); 2European Atherosclerosis Society (EAS); 3European Heart Network (EHN); 4European Renal Association - European Dialysis and Transplant Association (ERA-EDTA); 5European Society of Hypertension (ESH); 6European Stroke Organization (ESO); 7European Federation of Sports Medicine Association (EFSMA); 8European Geriatric Medicine Society (EuGMS); 9International Diabetes Federation Europe (IDF Europe); 10International Federation of Sport Medicine (FIMS); 11International Society of Behavioural Medicine (ISBM); 12International Society of Gender Medicine (IGM); 13World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA)  Europe

................................................................................................................................................................................................... Keywords Guidelines • prevention • personalized • population • risk estimation • lifetime risk • lifetime benefit • risk management • shared decision-making • stepwise approach • nutrition • smoking • healthy lifestyle • psychosocial factors • blood pressure • lipids • diabetes • smoking • air pollution • climate change

Table of Contents

1. Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3233 2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3234 2.1. Definition and rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3235 2.2. Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 2.3. Cost-effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 2.4. What is new? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 3. Risk factors and clinical conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 3.1. Target population for assessing cardiovascular disease risk . . 3236 3.2. Risk factors and risk classification . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 3.2.1. Risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3236 3.2.1.1 Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3242 3.2.1.2 Blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3242 3.2.1.3 Cigarette smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3242 3.2.1.4 Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3243 3.2.1.5 Adiposity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3243 3.2.2. Sex and gender and their impact on health . . . . . . . . . . . . . 3243 3.2.3. Atherosclerotic cardiovascular disease risk classification . 3243 3.2.3.1 A stepwise approach to risk factor treatment and treatment intensification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3243 3.2.3.2 Risk estimation in apparently healthy people . . . . . . . . . . . 3245 3.2.3.3 Translating cardiovascular disease risk to treatment thresholds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3250 3.2.3.4 Risk estimation and risk factor treatment in apparently healthy people 5069 years of age . . . . . . . . . . . . . . . 3253 3.2.3.5 Risk estimation and risk factor treatment estimation in apparently healthy people 70 years of age . . . . . 3253 Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026