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............................................................................................................................................................................. • There is strong evidence for medication-assisted interventions: NRT, bupropion, varenicline, and drugs in combination. The most effective are assistance using drug therapy and follow-up support. • Lower is better: the effect of LDL-C on the risk of CVD appears to be determined by both the baseline level and the total duration of exposure to LDL-C. • Lowering LDL-C with statins, ezetimibe, and—if needed and cost-effective—PCSK9 inhibitors, decreases the risk of ASCVD proportionally to the absolute achieved reduction in LDL-C. • When LDL-C goals according to level of risk cannot be attained, aim to reduce LDL-C by >_50% and then strive to reduce other risk factors as part of a shared decision-making process with the patient. • When hypertension is suspected, the diagnosis should be confirmed by repeated office BP measurement at different visits, or ABPM or HBPM. • Lifestyle interventions are indicated for all patients with hypertension and can delay the need for drug treatment or complement the BP-lowering effect of drug treatment. • BP-lowering drug treatment is recommended in many adults when office BP is >_140/90 mmHg and in all adults when BP is >_160/100 mmHg. • BP treatment goals are lower than in the previous ESC CVD prevention guidelines for all patient groups, including independent older patients. • Wider use of single-pill combination therapy is recommended to reduce poor adherence to BP treatment. • A simple drug treatment algorithm should be used to treat most patients, based on combinations of a reninangiotensin system (RAS) blocker with a CCB or thiazide/thiazide-like diuretic, or all three. Beta-blockers may also be used where there is a guideline-directed indication. • Many patients with hypertension will be at sufficient risk to benefit from statin therapy for primary prevention. Antiplatelet therapy is indicated for secondary prevention. • A multifactorial approach, including lifestyle changes, is critical in persons with type 2 DM. • Management of hyperglycaemia reduces the risk of microvascular complications and, to a lesser extent, the risk of CVD. Glycaemic targets should be relaxed in older adults and frail individuals. • New antihyperglycaemic drugs are particularly important for persons with type 2 DM with existing ASCVD and (heightened risk of) HF or renal disease, broadly irrespective of glycaemia levels.

Type 1 diabetes mellitus

• Intensive management of hyperglycaemia in DM reduces the risk of micro- and macrovascular complications and premature mortality; a target of 6.57.5% (4858 mmol/mol) HbA1c is recommended. • Metformin is not recommended in type 1 DM to lower CVD risk. • Dapagliflozin has been recommended for use in type 1 DM, although there is an increased risk of diabetic ketoacidosis with such therapies. • Targeting other risk factors, in particular smoking, BP, and cholesterol levels, remains an important means to lower CVD risk in type 1 DM. • All patients with established ASCVD require some form of antithrombotic therapy. • Anti-inflammatory therapy is a promising strategy in CVD prevention. • Patients after ACS and/or coronary artery bypass graft/PCI, or with chronic HFrEF, should participate as early as possible in structured, multidisciplinary EBCR and prevention programmes. • EBCR and prevention programmes must comply with certain quality standards and be individualized to each patient’s profile. • Participation and long-term adherence to these programmes has to be encouraged and enhanced. Telerehabilitation and mHealth may help towards achieving this target.

Population-level approaches to cardiovascular disease prevention Physical activity

• A significant percentage of the worldwide population, in particular the European population, shows high levels of sedentary behaviour and physical inactivity. • The percentage of those exercising at a regular level is greater in men than in women. • Global progress to increase PA has been slow, largely due to lack of awareness and investment. • The optimal dose of different types of PA for CVD and general prevention is still controversial and subjected to frequent updates. Increasing moderate-to-vigorous PA and reducing sitting time, however, is beneficial and any level of PA is considered better than none. • PA for health promotion should be implemented by physicians in the same way as drug prescription and should also be promoted by other healthcare professionals. • Population-based interventions are effective in promoting PA for groups based on age, sex, and race, for high-, middle-, and low-income populations, and for different environments (e.g. kindergarten, school, gyms, companies, and worksites in general). • Daily PA at school should be practised for at least 3 h/week, and preferably for 60 minutes per day. • Population-based approaches are complementary to individualcentred interventions. • Diet • Structural measures such as changes in agricultural supply chain and food industry, product reformulation, limitations on (digital) marketing to children, taxes on unhealthy foods/nutrients, and consumer-friendly nutrition labelling will improve healthy food choices. • Healthy environments in the community, on public transport, at schools, and in workplaces will stimulate a healthier lifestyle. • The WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases 20132020 extended to 2025 recommends to develop goals in global, regional, and national agendas. Within the 10 voluntary targets to reach in 2025 is a 30% relative reduction in mean population intake of sodium/ salt.830 Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026