European Society of Cardiology publishes recommendations on prevention of cardiovascular diseases

The European Society of Cardiology (ESC) has published its recommendations on the prevention of cardiovascular diseases (CVD) in clinical practice in the European Heart Journal.[1]The most important way to prevent these conditions is to adopt a healthy lifestyle throughout life, including not using tobacco and nicotine products, and to treat all risk factors.

The rationale for these recommendations is based on the fact that up to 90% of the risk of myocardial infarction, stroke or peripheral arterial disease (PAD) can be explained by smoking, poor eating habits, lack of physical activity, obesity, high blood pressure or alcohol consumption.

Tobacco, a major risk factor for cardiovascular diseases

Smoking is responsible for 50% of all preventable cardiovascular deaths in smokers, half of which are due to atherosclerosis, a build-up of plaque on the inner walls of the arteries. A lifelong smoker has a 50% chance of dying prematurely from smoking and loses an average of 10 years of quality life. The risk of CVD in smokers under 50 is five times higher than in non-smokers. The European Society of Cardiology also points out that prolonged smoking is even more dangerous for women than for men and that passive smoking is associated with an increased risk of CVD.

The recommendations also cover other tobacco products and highlight in particular the dangers of smokeless tobacco, which is also associated with an increased risk of fatal coronary heart disease.

Quitting smoking completely, the most effective measure

According to the ESC, total smoking cessation is the most effective measure to prevent cardiovascular events. Smoking cessation leads to substantial reductions in the number of heart attacks and associated deaths. Complete cessation should be encouraged in all smokers and passive smoking should be systematically avoided. For many patients at high risk of developing CVD, simply stopping smoking can move them to a lower risk category without taking medication. Even in heavy smokers (≥20 cigarettes/day), cessation reduces the risk of CVD within 5 years.

Beyond the need to strongly encourage all smokers to quit smoking by emphasizing the benefits to be expected, medical treatment is recommended, using products that have scientifically proven their effectiveness: nicotine substitutes, varenicline and bupropion.

The European Society of Cardiology states that although recent studies suggest that e-cigarettes may be effective in the short term for smoking cessation, the long-term effects on cardiovascular and pulmonary health are unclear and the dual use of e-cigarettes and tobacco cigarettes does not lead to a reduction in risk and should be avoided. Furthermore, as e-cigarettes are addictive, their use should be subject to similar marketing controls as tobacco cigarettes, particularly flavoured varieties that appeal to children. Finally, although it contains fewer toxic substances than tobacco cigarettes, ‘heated tobacco’ contains tobacco and should be discouraged.

Recommendations for tobacco intervention strategies

Beyond completely stopping smoking, the European Society of Cardiology issues a series of other recommendations to combat smoking with reference to WHO Framework Convention. As adolescence is the most vulnerable period during which smoking initiation and establishment usually take place, with lifelong consequences, continuous tax increases represent the most effective policy measure to reduce smoking among young people. The ESC also recalls that plain packaging and bans on tobacco advertising, promotion and sponsorship are effective in reducing the appeal of tobacco products. All tobacco and nicotine products, whatever they are (chewing tobacco, heated/grilled tobacco and e-cigarettes) must also be subject to restrictions due to the health risks. This arsenal of measures must be coordinated on the basis of good practices, at European level to achieve a smoke-free Europe by 2030.

Keywords: European Society of Cardiology, Cardiovascular Diseases, Prevention, Smoking

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[1] Frank LJ Visseren, François Mach, and al., 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC), European Heart Journal, 2021;, ehab484, https://doi.org/10.1093/eurheartj/ehab484

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