M84 NHG-Standaard Cardiovasculair risicomanagement (eerste herziening)

This guideline is an update of the guideline ‘Cardiovascular risk management’ in 2006, based on the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (2007) and additional literature searches. It provides an integral approach to all relevant risk factors for cardiovascular disease (CVD) caused by atherothrombosis. Patients with elevated blood pressure or cholesterol, a family history of premature CVD, renal impairment, smokers of 50 years or older, and patients with CVD, diabetes mellitus (DM), or rheumatoid arthritis (RA) are eligible for assessment of relevant risk factors for CVD. The guideline includes a table for estimating the risk of CVD (fatal and non-fatal events) for patients without CVD, based on Dutch cohort data. The table can also be used for patients with DM or RA by adding 15 years of age. High risk patients are defined as those with a risk of CVD ≥ 20%. All high-risk patients, including patients with CVD, should receive lifestyle counseling. In patients with CVD the use of acetylsalicylic acid and often, depending on the specific disease, a beta-blocker or an angiotensin converting enzyme (ACE)-inhibitor are recommended. In high-risk patients, drug treatment is recommended if the systolic blood pressure (SBD) is > 140 mmHg or LDL is > 2,5 mmol/l. The choice of antihypertensive drugs depends on comorbidity, co-medication and other individual patient characteristics. Combination therapy is preferred over high-dose single-drug therapy if the target value (SBD ≤ 140 mmHg) could not be reached. Simvastatin is first choice cholesterol lowering drug, based on cost effectiveness analyses. The guideline includes considered judgment for patients of 70 years or older and patients of 50 years and younger for individually tailoring the treatment plan. The follow-up plan is determined individually, depending on the risk profile, comorbidity, and patient’s preferences.