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............................................................................................................................................................................. Risk modifiers

• Psychosocial stress is associated with risk of ASCVD. • Current risk scores may under- or overestimate CVD risk in differing ethnic minority groups. • CAC scoring is the best-established imaging modality to improve CVD risk stratification. • Frailty is a functional risk factor of both CV and non-CV morbidity and mortality. • Frailty assessment is not a method to determine eligibility for any particular treatment, but rather serves to build an individualized care plan with predefined priorities. • Family history should be enquired about routinely, and a positive family history of premature ASCVD should be followed by comprehensive CVD risk assessment. • Current data does not support the use of genomic risk scores in CVD risk assessment in primary prevention. • ASCVD development and prognosis are linked to social gradients. • Air pollution is strongly associated with ASCVD. • Additional circulating and urine biomarkers should not be routinely measured. • Assess CVD risk in persons with obesity. Clinical conditions

• CKD is an independent risk factor for ASCVD, and ASCVD is the leading cause of death in CKD. • A short-term reduction in albuminuria by approximately 30% upon starting RAAS inhibition is associated with improved CV and kidney outcomes. • Similarly, SGLT2 inhibitors are associated with long-term benefits in CV and renal risks. • AF is associated with an increased risk of death and an increased risk of CVD. • Ischaemic HF constitutes the most advanced clinical manifestation of atherosclerosis within the myocardium. • The diagnosis of overt HF, as well as asymptomatic presentation with LV dysfunction, increases the risk of CVD events (myocardial infarction, ischaemic stroke, CV death). • There is an overlap between cancer and CV risk factors; CV risk in patients with cancer depends on both the CV toxicity of treatments and patient-related factors. • Signs or symptoms of cardiac dysfunction should be monitored before, periodically during, and after treatment. • Exercise should be strongly advised, in particular aerobic exercise, to prevent cardiotoxicity. • COPD is a major risk factor for CVD, especially ASCVD, stroke, and HF. • COPD patients are prone to arrhythmias (AF and ventricular tachycardia) and sudden cardiac death. • All COPD patients should be investigated for CVD. • Common COPD medications are usually safe in terms of CV adverse events. • Chronic inflammatory conditions increase CVD risk. • Infection with HIV is associated with an increased risk of LEAD and CAD. • There is an association between influenza and periodontitis infections and ASCVD. • Migraine, particularly migraine with aura, is an independent risk factor for stroke and ischaemic cardiac disease. • The risk of ischaemic stroke in subjects with migraine with aura is magnified by the use of combined hormonal contraceptives and cigarette smoking. • Non-restorative sleep and a sleep duration that varies significantly up or down from the optimum of 7 h are associated with increased CV risk. • Mental disorders are common in the general population (12month prevalence of 27%) and are associated with excess mortality. • The onset of CVD increases the risk of mental disorders by 2.2fold, leading to a worse prognosis. • Some mental disorders—even symptoms of anxiety and depression—are associated with the development of CVD and with a worse prognosis in those with existing CVD (CHD, arterial hypertension, AF, HF). • Excess mortality is mainly caused by behaviour-dependent risk factors (e.g. smoking addiction) and an impaired capacity for selfcare (e.g. treatment adherence). • NAFLD is associated with other cardiometabolic risk factors. • Patients with NAFLD should be evaluated for other cardiometabolic risk factors. • Sex-specific conditions: • Preeclampsia and pregnancy-related hypertension are associated with a higher risk of CVD.

• Polycystic ovary syndrome confers a significant risk for future development of DM. • ED is associated with future CV events and mortality in men. • CVD risk should be assessed in men with ED. • Asking about ED should be a standard procedure in routine CV risk assessment in men. Risk factors and interventions at the individual level

• Regular PA is a mainstay of ASCVD prevention. • Aerobic PA in combination with resistance exercise and the reduction of sedentary time are recommended for all adults. • A healthy diet lowers the risk of CVD and other chronic diseases. • A shift from a more animal- to plant-based food pattern may reduce CVD. • Achieving and maintaining a healthy weight through lifestyle changes has favourable effects on risk factors (BP, lipids, glucose metabolism) and lowers CVD risk. • When changes in diet and PA—as well as other conventional, non-invasive interventions—are unsuccessful, bariatric surgery should be considered for high-risk individuals. • Anti-obesity medications with protective ASCVD effects may also be considered. • Patients with mental disorders have sharply increased lifestyle risks that need recognition and treatment. • Mental healthcare improves stress symptoms and quality of life, reduces the risk of suicide, and may improve CV outcomes. • The treatment of ASCVD patients with mental disorders requires interdisciplinary cooperation and communication. • Stopping smoking rapidly reduces CVD risk and is the most cost-effective strategy for ASCVD prevention. Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026