European Guidelines on Cardiovascular Disease Prevention in Clinical Practice Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice .

Graham, Ian; Atar, Dan; Borch‐Johnsen, Knut; Boysen, Gudrun; Burell, Gunilla; Cífková, Renata; Dallongeville, Jean; Backer, Guy De; Ebrahim, S.; Gjelsvik, Bjørn; Herrmann‐Lingen, Christoph; Hoes, Arno W.; Humphries, Steve E.; Knapton, Mike; Perk, Joep; Priori, Silvia G.; Pyörälà, Kalevi; Reiner, Željko; Ruilope, Luis; Sans-Menéndez, Susana; Reimer, Wilma Scholte op; Weissberg, Peter L.; Wood, David; Yarnell, John; Zamorano, José Luís

doi:10.20996/1819-6446-2008-4-3-111-128

Cited by 178 publications

(307 citation statements)

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“…A consistently elevated BP is associated with increased cardiovascular risk leading to ischemic heart disease, stroke, and renal failure [6][7][8][9]17]. A MAP regularly greater than 110 is considered hypertensive [16].…”

Section: Discussionmentioning

confidence: 99%

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Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Gupta

Carter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Elevated blood pressure (BP) is associated with increased cardiovascular risks manifested by ischemic heart disease and stroke. Studies of cardiothoracic surgeons and neurosurgeons suggest surgery induces a hemodynamic stress malresponse. However, it is unclear whether these occur in orthopaedic surgeons. Questions/Purposes We measured the BP of surgeons during hallux valgus surgery, TKA, and THA with the: (1) trainee assisting the trainer, (2) the trainer assisting the trainee, (3) the trainee operating independently, and (4) compared the intraoperative changes in BP and heart rate of orthopaedic surgeons with those of a clinic day and during an exercise tolerance test.Methods We used an ambulatory BP monitor to measure the BP and heart rate of three consultants and their respective trainees during hallux valgus surgery, TKA, or THA. We noted if there were any differences in the stress response of the lead surgeon in comparison to when the same individual was assisting a trainee, and vice versa. Additionally, we recorded the trainee's BP and heart rate when they were operating independently. The intraoperative changes in BP and heart rate of orthopaedic surgeons were compared with those measured during a clinic day and during an exercise tolerance test. Results When the trainer was leading the operation, their mean arterial pressure gradually increased to 105 (range, 102-109) until implant placement. However, when the trainee was operating and the trainer assisting, the trainer's BP peaked (mean, 101; range, 95-111) at the beginning of the procedure and slowly declined as it progressed. The trainee's BP remained elevated throughout. The highest peaks for trainees were noted during independent operating. All of the surgeons had higher average BP readings (mean, 100; range, 95-108) and heart rate (mean, 86; range, 57-117) on days when they did surgery compared with baseline. Conclusions The elective operations studied induced a hypertensive response. The response was more marked in trainees than in trainers, particularly if the trainee was operating independently.

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Section: Discussionmentioning

confidence: 99%

“…myocardial infarction [4], transient cerebral ischemic attacks, and strokes [6,8,9,17]. Hypertension also is related to increased risks of chronic kidney disease and end-stage renal disease [7].…”

Section: Introductionmentioning

confidence: 99%

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Gupta

Carter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…The recommended first-line treatment for the majority of patients with raised LDL-C is lifestyle modification to include a Mediterranean-type diet, regular exercise, smoking cessation, and weight loss [2e4, 8,9,11,15,17,53,55,57]. In addition, statins should be prescribed for all high-to veryhigh risk patients that fail to achieve their recommended LDL-C target using non-pharmacological interventions [2e4, 8,9,11,15,53,55,57] and, according to the 2013 ESC/ EASD Guidelines for Diabetes, Pre-diabetes and CVDs, for all patients with T2D and high CV risk, irrespective of their baseline LDL-C level [8]. Although the recent guidelines from the AHA/ACC recommended high-and moderateintensity statin therapy rather than LDL-C targets, patients with T2D and either CVD or other risk factors were among those targeted for intensive LDL-C lowering [11].…”

Section: Guidelines For the Management Of Dyslipidaemia And Cvdmentioning

confidence: 99%

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar¹,

Ginsberg

Ray

et al. 2014

Atherosclerosis Supplements

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Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

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“…The cut-off point for identifying those who needed drug treatment for elevated blood pressure and cholesterol was a 10-year CVD mortality risk of ≥10% [9]. This was higher than the cut-off point used in the European guidelines (≥5%) [38,39]. This higher cut-off point was based on a cost-effectiveness analysis and on preventing an increase in the work load of general practitioners.…”

Section: Guidelines On Cardiovascular Risk Management 2006-2011mentioning

confidence: 99%

Cardiovascular risk management of hypertension and hypercholesterolaemia in the Netherlands: from unifactorial to multifactorial approach

2012

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About 30 years ago, the first Dutch unifactorial guidelines on hypertension and hypercholesterolaemia were developed. These guidelines have been revised several times, often after publication of landmark studies on new generations of drugs. In 1978, cut-off points for pharmacological treatment of hypertension were based on diastolic blood pressure values ≥115 mmHg, and in 2000 they were lowered to >100 mmHg. From 1997 onwards, cut-off points for systolic blood pressure values >180 mmHg were introduced, which became leading. In 1987, cut-offs for hypercholesterolaemia of ≥8 mmol/l were set and from 2006 pharmacological treatment was based on a total/HDL cholesterol ratio >8. Around 2000, treatment decisions for hypertension and/or hypercholesterolaemia were no longer based on high levels of individual risk factors, but on a multifactorial approach based on total risk of cardiovascular diseases (CVD), determined by a risk function. In the 2006 multidisciplinary guideline on cardiovascular risk management, the Framingham risk tables were replaced by European SCORE risk charts. A cut-off point of 10% CVD mortality was set in the Netherlands. In 2011, this cut-off point changed to 20% fatal plus nonfatal CVD risk. Nowadays, 'the lower the risk factors, the lower the absolute risk' is the leading paradigm in CVD prevention.

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European Guidelines on Cardiovascular Disease Prevention in Clinical Practice Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice .

Cited by 178 publications

References 0 publications

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Cardiovascular risk management of hypertension and hypercholesterolaemia in the Netherlands: from unifactorial to multifactorial approach

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