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Le Linee Guida ESC
sulla prevenzione
cardiovascolare
Stefano Urbinati
Vice Presidente ANMCO
UOC Cardiologia, Ospedale Bellaria, Bologna
Simposio
“Curiosare tra le nuove LLGG ESC 2016”
I “soliti” limiti della prevenzione CV
- Penalizzata economicamente
- Sempre subordinata agli investimenti
per l’acuto e per l’interventistica
- Non si sa mai chi ne è responsabile
- E’ cost-effective, ma non a breve termine
- A fronte della riduzione del fumo e di un
più efficace trattamento di ipertensione
e dislipidemie si registra un aumento di
obesità e diabete
JOINT ESC GUIDELINES
2016 European Guidelines on cardiovascular
disease prevention in clinical pract ice
The Sixth Joint Task Force of the European Society of Cardiology
and Other Societ ies on Cardiovascular Disease Prevent ion in
Clinical Pract ice (const ituted by representat ives of 10 societ ies
and by invited exper ts)
Developed with the special cont r ibut ion of the European Associat ion
for Cardiovascular Prevent ion & Rehabilitat ion (EACPR)
Authors/Task Force Members: Massimo F. Piepoli* (Chairperson) (Italy),
Arno W . Hoes* (Co-Chairperson) (The Nether lands), Stefan Agewall (Norway)1,
Chr ist ian Albus (Germany)9, Car los Brotons (Spain)10, Alber ico L. Catapano (Italy)3,
Mar ie-Therese Cooney (Ireland)1, Ugo Corr a (Italy)1, Bernard Cosyns (Belgium)1,
Chr ist i Deaton (UK)1, Ian Graham (Ireland)1, Michael Stephen Hall (UK)7,
F. D. Richard Hobbs (UK)10, Maja-Lisa Løchen (Norway)1, Herber t Lollgen
(Germany)8, Pedro Marques-Vidal (Switzer land)1, Joep Perk (Sweden)1, Eva Prescot t
(Denmark)1, Josep Redon (Spain)5, Dimit r ios J. Richter (Greece)1, Naveed Sat tar
(UK)2, Yvo Smulders (The Nether lands)1, Monica Tiber i (Italy)1,
H. Bart van der W orp (The Nether lands)6, Ineke van Dis (The Nether lands)4,
W . M. Monique Verschuren (The Nether lands)1
Addit ional Cont r ibutor : Simone Binno (Italy)
* Correspondingauthors:Massimo F.Piepoli,Heart FailureUnit, Cardiology Department, Polichirurgico Hospital G.DaSaliceto, Cantone Del Cristo,29121 Piacenza, EmiliaRomagna,
Italy, Tel: + 39 0523 30 32 17, Fax: + 39 0523 30 32 20, E-mail: [email protected], [email protected].
Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands,
Tel: + 31 88 756 8193, Fax: + 31 88 756 8099, E-mail: [email protected] .
ESC Commit tee for Pract ice Guidelines (CPG) and Nat ional Cardiac Societ ies document reviewers: listed in the Appendix.
ESC ent it ies having part icipated in the development of this document:
Associat ions: European Association for Cardiovascular Prevention & Rehabilitation (EACPR), European Association of Cardiovascular Imaging (EACVI), European Association of
Percutaneous Cardiovascular Interventions (EAPCI), Heart Failure Association (HFA).
Councils: Council on Cardiovascular Nursing and Allied Professions, Council for Cardiology Practice, Council on Cardiovascular Primary Care.
W orking Groups: Cardiovascular Pharmacotherapy
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the
ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of awritten request to Oxford
University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer . The ESC Guidelines represent the viewsof the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at
the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recom-
mendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encour-
aged 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 and, where appropriate and/or necessary, the patient’s caregiver. Nor
do the ESC Guidelines exempt health professionals from takinginto full and careful consideration the relevant official updated recommendations or guidelines issued by thecompetent
public health authorities, in order to manage each patient’scase in light of the scientifically accepted datapursuant to their respective ethical and professional obligations. It isalso the
health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
& The European Society of Cardiology 2016. All rights reserved. For permissions please email: [email protected].
European Heart Journal (2016) 37, 2315–2381
doi:10.1093/eurheartj/ehw106
Eur Heart J 2016; 37: 2315-81
Alcune novità rispetto alle
LLGG tradizionali
1. Non si soffermano solo sugli
obiettivi da perseguire, ma
insistono maggiormente sul
come perseguirli
Guidelines on CVD prevention
Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention
Eur Heart J 2016; 37: 2315-81
Per noi medici è sempre più “facile”
somministrare dei farmaci
piuttosto che modificare
delle abitudini di vita inveterate
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
140 90
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention
Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Come ?
Dove ?
Chi lo fa ?
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention.
Eur Heart J 2016; 37: 2315-81
Come ?
Dove ?
Chi lo fa ?
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Alcune novità rispetto alle
LLGG tradizionali
2. E’ importante comprendere
chi abbiamo davanti,
perché la comunicazione
dovrebbe essere diversa per
diverse categorie di persone
Guidelines on CVD prevention
Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
countries at high CV risk countries at low CV risk
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
10-year risk of fatal CV event
•Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Alcune novità rispetto alle
LLGG tradizionali
3. La prevenzione si fa
controllando i fattori di rischio
e non con attraverso una
“abusata” ricerca
di aterosclerosi asintomatica
Cosa non serve per fare prevenzione CV
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Cosa non serve per fare prevenzione CV
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Alcune novità rispetto alle
LLGG tradizionali
4. Considerano alcuni “nuovi”
fattori di rischio
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Alcune novità rispetto alle
LLGG tradizionali
5. Identificano quali sono i rispettivi
ambiti di responsabilità nell’ambito
della prevenzione CV tra medici,
politici e amministratori sanitari
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention. Eur Heart J 2016; 37: 2315-81
Guidelines on CVD prevention.
Eur Heart J 2016; 37: 2315-81
La scommessa
(perduta?) della
Riabilitazione Cardiologica
… interessi della Cardiologia
Riabilitativa a favorire la
Riabilitazione degenziale
… scarso interesse
della Cardiologia per acuti
Lo sviluppo della Riabilitazione Cardiologica
ambulatoriale è sempre stato penalizzato da …
Urbinati S, Olivari Z et al for the BLITZ 4 Inv.
Eur J Prev Cardiol 2015; 22: 1548-56
BLITZ 4 Registry
Alcune novità rispetto alle
LLGG tradizionali
6. Quello che viene fatto deve
poter essere “misurato”
(accountability)
Guidelines on CVD prevention.
Eur Heart J 2016; 37: 2315-81