p.42 抽出テキスト

................................................................... and benefits of individual treatment are the topic of this section. In all scenarios where recommendations for individual interventions to reduce risk are ‘strong’ (class I or IIa), it is important to realize that many patients who have received appropriate risk information often (in up to 50% of cases, some studies suggest) consciously opt to forego the proposed intervention. This applies not only to lifestyle measures, but also to drug interventions. Apparently, what professionals feel is sufficient risk reduction for a reasonable effort or initiation of a drug with few side-effects does not always correspond to patients’ views. The reverse is also true: not only may some patients at (very) high risk forego interventions, some patients with low-tomoderate risk may be highly motivated to decrease their risk even further. Hence, treatment recommendations are never ‘imperative’ for (very) high risk patients, nor are interventions ever ‘prohibited’ for patients at low-to-moderate risk. There is evidence that a higher proportion of women, compared to men, have a low awareness of their CVD risk and the need for therapeutic interventions. This warrants efforts to improve awareness, risk assessment, and treatment in women.52,346351

4.2 Optimizing cardiovascular risk

management 4.2.1. Goals of clinicianpatient communication Clinicians should provide a personalized presentation of guidelines to improve understanding, encourage lifestyle changes, and support adherence to drug therapy. Applying this in daily practice faces different barriers.352 Patients’ ability to adopt a healthy lifestyle depends on cognitive and emotional factors, the impact of a diagnosis or symptoms, socioeconomic factors, educational level, and mental health. Perceived susceptibility to illness and the anticipated severity of the consequences are also prominent components of patients’ motivation.353

4.2.2. How to improve motivation? Communication strategies such as motivational interviewing are useful.354 Consultation sessions may include a family member or friend, especially for elderly patients. Connection is paramount: focus before greeting; listen intently; agree on what matters most; connect with the person’s story; and explore emotions.355 The OARS (Open-ended questions, Affirmation, Reflective listening, and Summarizing) principle helps patients to present their perceptions, and clinicians to summarize. The SMART (Specific, Measurable, Achievable, Realistic, Timely) principle may help with setting goals for behavioural change.353,356 Healthcare professionals must consider capability, opportunity (physical, social, or environmental) and motivation for behavioural change.357 Multidisciplinary behavioural approaches that combine the knowledge and skills of different caregivers are recommended.358

4.2.3. Optimizing drug adherence Medication adherence ranges from 50% for primary ASCVD prevention to 66% for secondary prevention.359 Physicians should consider non-adherence in every patient and inquire non-judgmentally about it.360 Approximately 9% of cases of ASCVD in Europe can be attributed to poor medication adherence.361 Contributors to nonadherence include polypharmacy, complexity of drug/dose regimes, poor doctor-patient relationship, lack of disease acceptance, beliefs about consequences and side-effects, intellectual/cognitive abilities, mental disorders, physical limitations, financial aspects, and living alone.360,362364 Importantly, only substantial risk reduction motivates patients for preventive drug treatment, which obviates the need for appropriate risk communication.365,366 Depression is another important factor, and adequate treatment thereof improves adherence.367,368

Mobile phone applications may improve adherence to both medication and behavioural changes.369 Their use is easy and probably cost-effective.370

4.2.4. Treatment goals In the subsequent sections, different domains of individual treatment are discussed. Table 6 summarizes the treatment goals and some key interventions for different categories of patients. For additional information on risk categories and the principle of a stepwise approach to treatment targets, please refer to section 3.2.3.1. For details on treatment goals, how to achieve them, strengths of recommendations and levels of supporting evidence, please go to the relevant subsections.

4.3.Optimizing lifestyle 4.3.1. Physical activity and exercise

PA reduces the risk of many adverse health outcomes and risk factors in all ages and both sexes. There is an inverse relationship between moderate-to-vigorous PA and all-cause mortality, CV morbidity and

Recommendations for physical activity

Recommendations Classa Levelb

It is recommended for adults of all ages to strive for at least 150 - 300 min a week of moderateintensity or 75 - 150 min a week of vigorousintensity aerobic PA, or an equivalent combination thereof, to reduce all-cause mortality, CV mortality, and morbidity.371,372 I A It is recommended that adults who cannot perform 150 min of moderate-intensity PA a week should stay as active as their abilities and health condition allow.373,374 I B It is recommended to reduce sedentary time to engage in at least light activity throughout the day to reduce all-cause and CV mortality and morbidity.375377 I B Performing resistance exercise, in addition to aerobic activity, is recommended on 2 or more days per week to reduce all-cause mortality.378,379 I B Lifestyle interventions, such as group or individual education, behaviour-change techniques, telephone counselling, and use of consumer-based wearable activity trackers, should be considered to increase PA participation.380382 IIa B

CV = cardiovascular; PA = physical activity. aClass of recommendation. bLevel of evidence. ESC 2021

.......................................................................................................... Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026