Early prevention of cardiovascular events – recent data and practical approach

Authors: Jan Piťha 1,2
Authors‘ workplace: Kardiocentrum, Klinika kardiologie IKEM, Praha 1;  Centrum experimentální medicíny, Laboratoř pro výzkum aterosklerózy IKEM, Praha 2
Published in: AtheroRev 2022; 7(1): 14-20
Category: Reviews


There has been a great recent shift in the treatment of dyslipidemia in terms of the possibility of reducing atherogenic lipids; more gradual but not less successful development in the treatment of hypertension is observed. In the field of cardiovascular disease (CVD) prevention, in addition to combinations of statins and PCSK-9 inhibitors and/or or multiple antihypertensives, less aggressive, but earlier treatment of dyslipidemia and hypertension is increasingly being proposed. The reason is that in addition to the high mortality rate from CVD, uncontrolled risk factors create high number of individuals with poor quality of life, mostly including repeated hospitalizations; in other words, we spend a very long time in poor health conditions objectively represented the number and length of hospitalizations. One of strategies that could significantly improve this situation is the early initiation of risk factor intervention; especially in the case of dyslipidemia and hypertension. Current data are very encouraging. Our article focuses on scientific background and practical procedures in this treatment strategy. Several recommendations of the European Society of Cardiology have been also included.


hypertension – vascular age – cardiovascular disease – dyslipidemia – early prevention


1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1789–1858. Dostupné z DOI: 


2. Vrabcová J, Daňková Š, Faltysová K et al. Demografie 2017; 59(4): 315–331. Dostupné z WWW: <https://www.czso.cz/documents/10180/46203814/Demografie+4_2017.pdf/91887207–88f3–4bc-3–99f8–6701a032d067?version=1.1>.

3. Boavida JM, Capodanno D, Cosyns B et al. [ESC National Cardiac Societies; ESC Scientific Document Group]. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42(34): 3227– 3337. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehab484>.

4. Guidelines ESC 2021: Prevence KV onemocnění v klinické praxi. Dostupné z WWW: <https://www.tribune.cz/medicina/guidelines-esc--2021-prevence-kv-onemocneni-v-klinicke-praxi/>.

5. Demografický profil pacientů hospitalizovaných v ČR pro akutní IM v roce 2017 (dle NRHZS rok 2017). In: Akutní koronární syndromy (infarkt myokardu a nestabilní angina pectoris) – diagnostika a léčba. Dostupné z WWW: <https://kdp.uzis.cz/res/guideline/akutni-koronarni-syndromy-infarkt-myokardu-nestabilni-angina-pectoris-diagnostika-lecba-final.pdf>.

6. Propad v prevencích je znatelný, snad se podaří dohnat. Dostupné z WWW: <https://www.tribune.cz/medicina/propad-v-prevencich-je-znatelny-snad-se-podari-dohnat/>.

7. Ben-Shlomo Y, Spears M, Boustred C et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta- analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014; 63(7): 636–646. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2013.09.063>.

8. Cuende JI, Cuende N, Calaveras-Lagartos J. How to calculate vascular age with the SCORE project scales: a new method of cardiovascular risk evaluation. Eur Heart J 2010; 31(19): 2351–2358. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehq205>.

9. Ong KT, Delerme S, Pannier B et al. [investigators]. Aortic stiffness is reduced beyond blood pressure lowering by short-term and long-term antihypertensive treatment: a meta-analysis of individual data in 294 patients. J Hypertens 2011; 29(6): 1034–1042. Dostupné z DOI: <http://dx.doi.org/10.1097/HJH.0b013e328346a583>.

10. Upala S, Wirunsawanya K, Jaruvongvanich V et al. Effects of statin therapy on arterial stiffness: A systematic review and meta-analysis of randomized controlled trial. Int J Cardiol 2017; 227: 338–341. Dostupné z DOI: <http://dx.doid.org/10.1016/j.ijcard.2016.11.073>.

11. Williams B, Lacy PS, Thom SM et al. [CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee]. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113(9): 1213–1225. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595496>.

12. Williams B, Mancia G, Spiering W et al. [ESC Scientific Document Group]. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39(33): 3021–3104. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehy339>.

13. Tuzcu EM, Kapadia SR, Tutar E et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001; 103(22): 2705–2510. Dostupné z DOI: <http://dx.doi.org/10.1161/01.cir.103.22.2705>.

14. Ettehad D, Emdin CA, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta- analysis. Lancet 2016; 387(10022): 957–967. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(15)01225–8>.

15. Ference BA, Bhatt DL, Catapano AL et al. Association of Genetic Variants Related to Combined Exposure to Lower Low-Density Lipoproteins and Lower Systolic Blood Pressure With Lifetime Risk of Cardiovascular Disease. JAMA 2019; 322(14): 1381–1391. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2019.14120>.

16. Böhm M, Schumacher H, Teo KK et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet 2017; 389(10085): 2226–2237. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(17)30754–7>.

17. Rawshani A, Rawshani A, Franzén et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2018; 379(7): 633–644. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1800256>.

18. Ahmadi A, Narula J. Primary and Secondary Prevention, or Subclinical and Clinical Atherosclerosis. JACC Cardiovasc Imaging 2017 ;10(4): 447– 450. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jcmg.2016.08.002>.

19. Nicholls SJ, Tuzcu EM, Sipahi I et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA 2007; 297(5): 499–508. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.297.5.499>.

20. Is sequential treatment of dyslipidaemia effective in clinical practice? Dostupné z WWW: <https://www.medicalacademic.co.za/news/is-sequential-treatment-of-dyslipidaemia-effective-in-clinical-practice>.

21. Emberson J, Whincup P, Morris R et al. Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Eur Heart J 2004; 25(6): 484–491. Dostupné z DOI: <http://dx.doi.org/10.1016/j.ehj.2003.11.012>.

22. Khunti K, Danese MD, Kutikova et al. Association of a Combined Measure of Adherence and Treatment Intensity With Cardiovascular Outcomes in Patients With Atherosclerosis or Other Cardiovascular Risk Factors Treated With Statins and/or Ezetimibe. JAMA Netw Open 2018; 1(8): e185554. Dostupné z DOI: <http://dx.doi.org/10.1001/jamanetworkopen.2018.5554>.

Angiology Diabetology Internal medicine Cardiology General practitioner for adults
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account