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................................. programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient or the patient’s caregiver where appropriate and/or necessary. It is also the health professional’s responsibility to verify the rules and regulations applicable in each country to drugs and devices at the time of prescription. 2 Introduction Atherosclerotic cardiovascular (CV) disease (ASCVD) incidence and mortality rates are declining in many countries in Europe, but it is still a major cause of morbidity and mortality. Over the past few decades, major ASCVD risk factors have been identified. The most Table 2 Levels of evidence Level of evidence A Data derived from multiple randomized clinical trials or meta-analyses. Level of evidence B Data derived from a single randomized clinical trial or large non-randomized studies. Level of evidence C Consensus of opinion of the experts and/or small studies, retrospective studies, registries. ©ESC 2021 Table 1 Classes of recommendations ©ESC 2021 Classes of recommendations Class I Evidence and/or general agreement that a given treatment or procedure is Is recommended or is indicated Wording to use Class III Evidence or general agreement that the given treatment or procedure is not useful/effective, and in some cases may be harmful. Is not recommended Class IIb established by evidence/opinion. May be considered Class IIa Weight of evidence/opinion is in Should be considered Class II Downloaded from academic.oup.com/eurheartj/article/42/34/3227/6358713 by guest on 07 October 2026