Skip to main content
SpringerLink
Log in

Cardiovascular Prevention in Clinical Practice (ESC and German Guidelines 2007)

Kardiovaskuläre Prävention im klinischen Alltag

  • Published:
Herz Kardiovaskuläre Erkrankungen Aims and scope Submit manuscript

Abstract

Preventive efforts should be guided by the patient’s global cardiovascular (CV) risk. A risk stratification should be done in every person > age 35 with more than a single risk factor. Recommendations for improved lifestyle are applicable to all persons with CV risk factors: smoking cessation, daily exercise, normal body mass index, Mediterranean diet, blood pressure < 140 mmHg systolic, and LDL cholesterol < 130 mg/dl are beneficial. If the 10-year risk is ≥ 20% for CV events or ≥ 5% for CV death, additional drug interventions are usually necessary: acetylsalicylic acid 100 mg daily, statins to lower LDL cholesterol to < 100 mg/dl or, in diabetics with coronary artery disease, to < 70 mg/dl, blood pressure should be < 130 mmHg systolic, e.g., in patients with diabetes or renal disease. After bare-metal stent implantation clopidogrel should be given for ≥ 4 weeks and after drug-eluting stents for ≥ 6 months. In patients after myocardial infarction with an ejection fraction of < 40%, ACE inhibitors and β-blocker should be started. Influenza vaccination improves prognosis in high-risk patients.

Zusammenfassung

Präventive Maßnahmen sollten in Abhängigkeit vom Gesamtrisiko erfolgen. Bei einem Alter > 35 Jahre und mehr als einem Risikofaktor sind eine Risikostratifikation und Bestimmung der „number needed to treat“ (NNT) sinnvoll:

1. Empfehlungen für Patienten mit niedrigem und mittlerem Ereignisrisiko: Bei einem 10-Jahres-Risiko für kardiovaskuläres Ereignis < 20%/kardiovaskulären Tod < 5% oder einer NNT > 200 (häufig entsprechend einer Primärprävention) gelten folgende Empfehlungen:

→ Rauchen: eindeutige ärztliche Empfehlung, das Rauchen vollständig einzustellen; Einbeziehung des Partners oder der Familie; Anbieten von Raucherentwöhnungsprogrammen, evtl. mit medikamentöser Unterstützung.

→ Ernährung: fettarme, kaloriengerechte, antiatherogene Kost im Sinne der mediterranen Kost.

→ Lipide: Bei einem LDL-Cholesterin von ≥ 160 mg/dl (4,13 mmol/l) und weiteren Risikofaktoren sollten zusätzlich zur mediterranen Kost Statine erwogen werden.

→ Körperliche Aktivität: Ziel: mindestens vier- bis fünfmal pro Woche 30–45 min mäßig intensive Bewegung, unterstützt durch eine aktivere Lebensweise.

→ Blutdruck: Zielwert ist ein Blutdruck von < 140/90 mmHg; β-Blocker sind nicht Medikamente erster Wahl.

→ Hormonersatztherapie (bei Frauen): Eine Hormonersatztherapie zur Prophylaxe von kardiovaskulären Erkrankungen ist nicht zu empfehlen.

→ Eine gute Arzt-Patient-Beziehung fördert das Gesundheitsverhaltens; psychosoziale Faktoren können die Compliance und die Behandlung erschweren.

→ Antioxidanzien und Vitamine: Für Antioxidanzien und Vitamine in Tablettenform ist kein primäroder sekundärpräventiver Effekt nachgewiesen.

2. Empfehlungen für Patienten mit höherem Ereignisrisiko: Bei einem 10-Jahres-Risiko für kardiovaskuläres Ereignis ≥ 20%/kardiovaskulären Tod ≥ 5 % oder einer NNT ≤ 200 (häufig entsprechend einer Sekundärprävention) gelten alle obigen Empfehlungen, aber zusätzlich folgende Maßnahmen:

→ Lipide: Erreichen des LDL-Cholesterin von < 100 mg/dl (2,58 mmol/l) mit einem Statin. Bei erhöhtem Gesamtrisiko und diffusem Gefäßbefall sind LDL-Werte < 70 mg/dl (< 1,8 mmol/l) anzustreben.

→ Blutdruck: Für Patienten mit Diabetes mellitus oder einer Nephropathie sollte der Blutdruck auf < 130/80 mmHg abgesenkt werden (Klasse-I-Empfehlung, Evidenzgrad A).

→ Aggregationshemmer: Acetylsalicylsäure (ASS) 100 mg/Tag als Dauermedikation. Bei Kontraindikation gegen ASS Clopidogrel 75 mg/Tag, alternativ evtl. Einstellung mit Marcumar in einem INR-Bereich (International Normalized Ratio) von 2,0–3,0.

→ Nach Stentimplantation:

– unbeschichteter Stent: mindestens 4 Wochen Clopidogrel zusätzlich zu ASS 100 mg;

– beschichteter Stent: mindestens 6 Monate Clopidogrel zusätzlich zu ASS 100 mg, bei Risikopatienten („off-label use“) 12 Monate.

→ Nach instabiler Angina pectoris: Clopidogrel für 9 Monate, auch bei konservativer Therapie.

→ ACE-Hemmer: zur Verhinderung und Behandlung der Herzinsuffizienz bei eingeschränkter Ventrikelfunktion.

Zur Verminderung koronarer Ereignisse, insbesondere bei Diabetikern und Patienten mit erhöhtem Risiko:

→ β-Blocker: bei Postinfarkt- und Hochrisikopatienten mit linksventrikulärer Dysfunktion und/oder bei belastungsinduzierter Ischämie.

→ Grippeschutzimpfung: regelmäßig jeden Herbst für Patienten mit hohem Risiko!

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Keil U, Fitzgerald AP, Gohlke H, et al. [Risk of death from heart-circulatory diseases. The new SCORE — Germany - tables for primary prevention.] Dtsch Ärztebl 2005;102: A1808–12.

    Google Scholar 

  2. Stamler J, Stamler R, Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;282:2012–8.

    Article  PubMed  CAS  Google Scholar 

  3. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007;356:2388–98.

    Article  PubMed  CAS  Google Scholar 

  4. Hardoon SL, Whincup PH, Lennon LT, et al. How much of the recent decline in the incidence of myocardial infarction in British men can be explained by changes in cardiovascular risk factors? Evidence from a prospective population-based study. Circulation 2008;117:598–604.

    Article  PubMed  Google Scholar 

  5. Diabetes Prevention Program Research Group. Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care 2003;26:2518–23.

    Article  Google Scholar 

  6. Greving JP, Buskens E, Koffijberg H, et al. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation 2008;117:2875–83.

    Article  PubMed  Google Scholar 

  7. Löwel H, Melsinger C, Heier M, et al. Sex specific trends of sudden cardiac death and acute myocardial infarction: results of the population-based KORA/MONICA-Augsburg Register 1985 to 1998. Dtsch Med Wochenschr 2002;127: 2311–6.

    Article  PubMed  Google Scholar 

  8. Smith SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006;113:2363–72.

    Article  PubMed  Google Scholar 

  9. Graham I, Atar D, Borch-Johnsen K, et al. 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 (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007;14:Suppl 2:S1–113.

    Article  PubMed  Google Scholar 

  10. Gohlke H, Albus C, Bönner G, et al. Pocket-Leitlinien: risikoadjustierte Prävention von Herz und Kreislauferkrankungen (http://www.leitlinien.dgk.org; Pocket Leitlinien, accessed November 1, 2008).

  11. Lauterbach KW, Gerber A, Klever-Deichert G, et al. Cost effectiveness of prevention of coronary disease in Germany. Z Kardiol 2005;94:Suppl 3::III/100–4.

    Google Scholar 

  12. Colhoun HM, Betteridge DJ, Durrington PN, et al., on behalf of the CARDS Investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364:685–96.

    Article  PubMed  CAS  Google Scholar 

  13. Steg PG, Bhatt DL, Wilson PWF, et al., for the REACH Registry Investigators. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007;297: 1197–206.

    Article  PubMed  CAS  Google Scholar 

  14. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the PROspective CArdiovascular Münster (PROCAM) study. Circulation 2002;105:310–5.

    Article  PubMed  Google Scholar 

  15. Gohlke H, Winter M, Karoff M, et al. CARRISMA: a new tool to improve risk stratification and guidance of patients in cardiovascular risk management in primary prevention. Eur J Cardiovasc Prev Rehabil 2007;14:141–8.

    Article  PubMed  Google Scholar 

  16. Ezzati M, Van der Hoorn S, Rodgers A, et al., the Comparative Risk Assessment Collaborating Group. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 2003;362:271–80.

    Article  PubMed  Google Scholar 

  17. Gohlke H. Prävention durch Lebensstiländerung: Was ist gesichert? Herz 2004;29:139–44.

    Article  PubMed  Google Scholar 

  18. Bartecchi CE, MacKenzie TD, Schrier RW. The human costs of tobacco use (first of two parts). N Engl J Med 1994;330: 907–12.

    Article  PubMed  CAS  Google Scholar 

  19. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937–52.

    Article  PubMed  Google Scholar 

  20. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease. An update. J Am Coll Cardiol 2004;43:1731–7.

    Article  PubMed  CAS  Google Scholar 

  21. Meisinger C, Baumert J, Khuseyinova N, et al. Plasma oxidized low-density lipoprotein, a strong predictor for acute coronary heart disease events in apparently healthy, middle-aged men from the general population. Circulation 2005;112:651–7.

    Article  PubMed  CAS  Google Scholar 

  22. Löwel H, Meisinger C, Heier M, et al. The population-based acute myocardial infarction (AMI) registry of the MONICA/KORA study region of Augsburg. Gesundheitswesen 2005; 67:31–7.

    Article  Google Scholar 

  23. Gohlke H, Yusuf S. Quantitating loss of life by smoking a single cigarette. Clin Res Cardiol 2007;96:522–3.

    Article  PubMed  Google Scholar 

  24. Anthonisen NR, Skeans MA, Wise RA, et al., for the Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality a randomized clinical trial. Ann Intern Med 2005;142:233–9.

    PubMed  Google Scholar 

  25. Van Domburg RT, Scholte op Reimer W, Hoeks SE, et al. Three life-years gained from smoking cessation after coronary artery bypass surgery: A 30-year follow-up study Am Heart J 2008;156:473–6.

    Article  PubMed  Google Scholar 

  26. Raupach T, Schäfer K, Konstantinides S, et al. Passive smoking has immediate effects on the clotting system and endothelial function. Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm. Eur Heart J 2006;27:386–92.

    Article  PubMed  Google Scholar 

  27. Blair SN, Kampert JB, Kohl HWIII, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205–10.

    Article  PubMed  CAS  Google Scholar 

  28. König D, Bönner G, Berg A. Bedeutung von Adipositas und Bewegungsmangel in der kardiovaskulären Primärprävention. Herz 2007;32:553–9.

    Article  PubMed  Google Scholar 

  29. Lakka TA, Venäläinen JM, Rauramaa R, et al. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med 1994;330:1549–54.

    Article  PubMed  CAS  Google Scholar 

  30. Manson JAE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341:650–8.

    Article  PubMed  CAS  Google Scholar 

  31. Paffenbarger RS, Hyde RT, Wing AL, et al. Physical activity, all cause mortality and longevity of college alumni. N Engl J Med 1986;314:605–13.

    PubMed  Google Scholar 

  32. Sandvik L, Erikssen J, Thaulow E, et al. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993;328:533–7.

    Article  PubMed  CAS  Google Scholar 

  33. Hu FB, Willett WC, Li T, et al. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004;351:2694–703.

    Article  PubMed  CAS  Google Scholar 

  34. Sesso HD, Paffenbarger RS, Lee I-M. Physical activity and coronary heart disease in men. The Harvard Alumni Health Study. Circulation 2000;102:975–80.

    PubMed  CAS  Google Scholar 

  35. Lee I-M, Sesso HD, Oguma Y, et al. The “weekend warrior” and risk of mortality. Am J Epidemiol 2004;160:636–41.

    Article  PubMed  Google Scholar 

  36. Bijnen FCH, Caspersen CJ, Feskens EJM, et al. Physical activity and 10-year mortality from cardiovascular diseases and all causes: the Zutphen Elderly Study. Arch Intern Med 1998;158:1499–505.

    Article  PubMed  CAS  Google Scholar 

  37. Hakim AA, Curb JD, Petrovitch H, et al. Effects of walking on coronary heart disease in elderly men — the Honolulu Heart Program. Circulation 1999;100:9–13.

    PubMed  CAS  Google Scholar 

  38. Schuler G. Körperliche Aktivität. Z Kardiol 2005;94:III/11–4.

    Article  Google Scholar 

  39. Predel H-G, Schramm T. Körperliche Aktivität bei arterieller Hypertonie. Herz 2006;31:525–30.

    Article  PubMed  Google Scholar 

  40. Linke A, Möbius-Winkler S, Hambrecht R. Körperliches Training in der Behandlung von KHK und Adipositas. Herz 2006;31:224–33.

    Article  PubMed  Google Scholar 

  41. Hambrecht R. Sport als Therapie. Herz 2004;29:381–90.

    Article  PubMed  Google Scholar 

  42. Hanefeld M, Metzler W, Köhler C, et al. Das metabolische Syndrom: „common soil” für Diabetes und Atherosklerose. Neue Möglichkeiten für eine integrierte Therapie. Herz 2006;31:246–54.

    Article  PubMed  Google Scholar 

  43. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998; 6:Suppl 2:51S–209S.

    Google Scholar 

  44. Giacchetti G, Faloia E, Mariniello B, et al. Overexpression of the renin-angiotensin system in human visceral adipose tissue in normal and overweight subjects. Am J Hypertens 2002;15:381–8.

    Article  PubMed  CAS  Google Scholar 

  45. Bastard JP, Jardel C, Bruckert E, et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 2000;85:3338–42.

    Article  PubMed  CAS  Google Scholar 

  46. Yudkin JS, Stehouwer CD, Emeis JJ, et al. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999;19:972–8.

    PubMed  CAS  Google Scholar 

  47. Keaney JF, Larson MG, Vasan RS, et al. Obesity and systemic oxidative stress: clinical correlates of oxidative stress in the Framingham Study. Arterioscler Thromb Vasc Biol 2003; 23:434–9.

    Article  PubMed  CAS  Google Scholar 

  48. Seals DR, Gates PE. Stiffening our resolve against adult weight gain [Editorial]. Hypertension 2005;45:175–7.

    Article  PubMed  CAS  Google Scholar 

  49. Murphy NF, MacIntyre K, Stewart S, et al. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley-Study). Eur Heart J 2006;27:96–106.

    Article  PubMed  CAS  Google Scholar 

  50. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187–93.

    Article  PubMed  Google Scholar 

  51. McGill HCJr, McMahan CA, Herderick EE, et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 2002;105:2712–8.

    Article  PubMed  Google Scholar 

  52. McMahan CA, Gidding SS, Fayad ZA, et al., for the Pathobiological Determinants of Atherosclerosis in Youth Research Group. Risk scores predict atherosclerotic lesions in young people. Arch Intern Med 2005;165:883–90.

    Article  PubMed  Google Scholar 

  53. Mora S, Yanek LR, Moy TF, et al. Interaction of body mass index and Framingham Risk Score in predicting incident coronary disease in families. Circulation 2005;111:1871–6.

    Article  PubMed  Google Scholar 

  54. Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003;138:24–32.

    PubMed  Google Scholar 

  55. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348: 1625–38.

    Article  PubMed  Google Scholar 

  56. Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097–105.

    Article  PubMed  CAS  Google Scholar 

  57. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999;354:447–55.

    Article  Google Scholar 

  58. Mitrou PN, Kipnis V, Thiébaut ACM, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 2007;167:2461–8.

    Article  PubMed  Google Scholar 

  59. Djoussé L, Gaziano JM. Alcohol consumption and risk of heart failure in the Physicians’ Health Study I. Circulation 2007;115:34–9.

    Article  PubMed  Google Scholar 

  60. Singer MV, Teyssen S. Serie Alkoholismus — alkoholassozi-ierte Organschäden. Dtsch Ärztebl 2001;98:A2109–20.

    Google Scholar 

  61. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J 2002;324:71–86.

    Article  Google Scholar 

  62. Juul-Müller S, Edvardsson N, Jahnmatz B, et al., the Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992;340:1421–5.

    Article  Google Scholar 

  63. Mangano DT, for the Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med 2002;347:1309–17.

    Article  PubMed  CAS  Google Scholar 

  64. Gaspoz JM, Coxson PG, Goldman PA, et al. Cost effectiveness of aspirin, clopidogrel, or both for secondary prevention of coronary heart disease. N Engl J Med 2002;346: 1800–6.

    Article  PubMed  Google Scholar 

  65. Nicolucci A, De Berardis G, Sacco M, et al. AHA/ADA vs. ESC/EASD recommendations on aspirin as a primary prevention strategy in people with diabetes: how the same data generate divergent conclusions. Eur Heart J 2007;28:1925–7.

    Article  PubMed  CAS  Google Scholar 

  66. Belch J, MacCuish A, Campbell I, et al., on behalf of the Prevention of Progression of Arterial Disease and Diabetes Study Group, Diabetes Registry Group, and Royal College of Physicians Edinburgh. The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:a1840.

    Article  PubMed  Google Scholar 

  67. European Society of Cardiology. Cardiovascular disease prevention in clinical practice: pocket guidelines. Sophia Antipolis: European Society of Cardiology, 2007 ( http://www.escardio.org/guidelines-surveys/products/pocket/Pages/PREV.aspx ).

    Google Scholar 

  68. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329–39.

    Article  Google Scholar 

  69. Hamm CW, Arntz H-R, Bode C, et al. Leitlinien. Akutes Koronarsyndrom (ACS) Teil 1: ACS ohne persistierende ST-Hebung. Z Kardiol 2004;93:72–90.

    Article  PubMed  CAS  Google Scholar 

  70. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy of cholesterol-owering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117–25.

    Article  CAS  Google Scholar 

  71. Ridker PM, Danielson E, Fonseca FAH, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008;359:2195–207.

    Article  PubMed  CAS  Google Scholar 

  72. Deedwania P, Barter P, Carmena R, et al., for the Treating to New Targets Investigators. Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets Study. Lancet 2006;368:919–28.

    Article  PubMed  CAS  Google Scholar 

  73. Cannon CP, Braunwald E, McCabe CH, et al., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy — Thrombolysis in Myocardial Infarction 22 Investigators. Comparison of intensive and moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350:1495–504.

    Article  PubMed  CAS  Google Scholar 

  74. Ray KK, Cannon CP, McCabe CH, et al., for the PROVE IT-TIMI 22 Investigators. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes. Results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005;46:1405–10.

    Article  PubMed  CAS  Google Scholar 

  75. Yusuf S, Peto R, Lewis J, et al. Beta-blockade during and after myocardial infarction: an overview of randomized trials. Prog Cardiovasc Dis 1985;27:335–71.

    Article  PubMed  CAS  Google Scholar 

  76. Packer M, Coats AJS, Fowler MB, et al., for the Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl JMed 2001;344:1651–8.

    Article  CAS  Google Scholar 

  77. Gibbons RJ, Abrams J, Chatterjee K, et al., American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Committee on the Management of Patients with Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina — summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Chronic Stable Angina). Circulation 2003;107:149–58.

    Article  PubMed  Google Scholar 

  78. Bangalore S, Messerli FH, Kostis JB, et al. Cardiovascular protection using beta-blockers. A critical review of the evidence. J Am Coll Cardiol 2007;50:563–72.

    Article  PubMed  CAS  Google Scholar 

  79. Bangalore S, Sawhney S, Messerli FH. Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol 2008;52:1482–9.

    Article  PubMed  CAS  Google Scholar 

  80. AIRE Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet 1993; 342:821–8.

    Google Scholar 

  81. Pfeffer MA, McMurray JJV, Velazquez EJ, et al., for the Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893–906.

    Article  PubMed  CAS  Google Scholar 

  82. Torp-Pedersen C, Kober L. Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation. Lancet 1999; 354:9–12.

    Article  PubMed  CAS  Google Scholar 

  83. Flather MD, Yusuf S, Køber L, et al., for the ACE-Inhibitor Myocardial Infarction Collaborative Group. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 2000;355:1575–81.

    Article  PubMed  CAS  Google Scholar 

  84. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145–53.

    Article  Google Scholar 

  85. The PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004;351:2058–68.

    Article  Google Scholar 

  86. Hackam DG, Thiruchelvam D, Redelmeier DA. Angiotensin-converting enzyme inhibitors and aortic rupture: a population- based case-control study. Lancet 2006;368:659–65.

    Article  PubMed  CAS  Google Scholar 

  87. Jong P, Demers C, McKelvie RS, et al. Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials. J Am Coll Cardiol 2002;39:463–70.

    Article  PubMed  CAS  Google Scholar 

  88. Pfeffer MA, Braunwald E, Moye LA, et al., The SAVE Investigators. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. N Engl J Med 1992;327:669–77.

    PubMed  CAS  Google Scholar 

  89. Yusuf S, Diener H-C, Sacco RL, et al. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008;359:1225–37.

    Article  PubMed  CAS  Google Scholar 

  90. The ALLHAT Collaborative Research Group. Major outcomes in high risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Sponsored by the National Heart, Lung, and Blood Institute (NHLBI). JAMA 2002;288:2981–97.

    Article  Google Scholar 

  91. Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a meta-analysis. Lancet 2001;358:1305–15.

    Article  PubMed  CAS  Google Scholar 

  92. Pitt B, Remme W, Zannad F, et al., for the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348: 1309–21.

    Article  PubMed  CAS  Google Scholar 

  93. Lewis EF, Moye LA, Rouleau JL, et al. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol 2003;42:1446–53.

    Article  PubMed  Google Scholar 

  94. Anselmino M, Gohlke H, Mellbin L, et al. Cardiovascular prevention in patients with diabetes and prediabetes. Herz 2008;33:170–7.

    Article  PubMed  Google Scholar 

  95. Davis MM, Taubert K, Benin AL, et al. Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology: this science advisory is consistent with the recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices. Circulation 2006;114:1549–53.

    Article  PubMed  Google Scholar 

  96. Gurfinkel EP, Leon de la Fuente R, Mendiz O, et al. Flu Vaccination in Acute Coronary Syndromes and Planned Percutaneous coronary Interventions (FLUVACS) study. Eur Heart J 2004;25:25–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 1Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany

    Helmut Gohlke

  2. Department of Psychosomatics and Psychotherapy, University Hospital, Cologne, Germany

    Christian Albus

  3. Am Ka Re, Ambulante Kardiologische Rehabilitation GmbH, Cologne, Germany

    Detlef Bernd Gysan

  4. Waldburg-Zeil Kliniken – Klinik Schwabenland, Isny-Neutrauchburg, Germany

    Harry W. Hahmann

  5. Rehabilitationszentrum München and Cardiologic Practice, Munich, Germany

    Peter Mathes

  6. Chefarzt Klinische Kardiologie II, Herz-Zentrum Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany

    Helmut Gohlke

Authors
  1. Helmut Gohlke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Albus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Detlef Bernd Gysan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harry W. Hahmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Mathes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helmut Gohlke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gohlke, H., Albus, C., Gysan, D.B. et al. Cardiovascular Prevention in Clinical Practice (ESC and German Guidelines 2007). Herz 34, 4–14 (2009). https://doi.org/10.1007/s00059-009-3196-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-009-3196-7

Key Words:

Schlüsselwörter:

Search

Navigation