Recomendações Europeias para a prevenção da doença cardiovascular na prática clínica (versão de 2012)

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Substantial improvement of primary cardiovascular prevention by a systematic score-based multimodal approach: A randomized trial: The PreFord-Study

Trial design Prospective randomized multicentre interventional study. Methods Individual cardiovascular risk assessment in Ford Company, Germany employees (n=4.196), using the European Society of Cardiology-Systematic Coronary Risk Evaluation (ESC-SCORE) for classification into three risk groups. Subjects assigned to ESC high-risk group (ESC-SCORE5%), without a history of cardiovascular disease were eligible for randomization to a multimodal 15-week intervention programme (INT) or to usual care and followed up for 36 months. Objectives Evaluation of the long-term effects of a risk-adjusted multimodal intervention in high-risk subjects. Primary endpoint: reduction of ESC-SCORE in INT versus usual care. Secondary endpoints: composite of fatal and non-fatal cardiovascular events and time to first cardiovascular event. Statistical analysis: intention-to-treat and per-protocol analysis. Results Four hundred and forty-seven subjects were randomized to INT (n=224) or to usual care (n=223). After 36 months ESC-SCORE development favouring INT was observed (INT: 8.70% to 10.03% vs. usual care: 8.49% to 12.09%; p=0.005; net difference: 18.50%). Moreover, a significant reduction in the composite cardiovascular events was observed: (INT: n=11 vs. usual care: n=27). Hazard ratio of intervention versus control was 0.51 (95% confidence interval 0.25-1.03; p=0.062) in the intention-to-treat analysis and 0.41 (95% confidence interval 0.18-0.90; p=0.026) in the per-protocol analysis, respectively. No intervention-related adverse events or side-effects were observed. Conclusions Our results demonstrate the efficiency of identifying cardiovascular high-risk subjects by the ESC-SCORE in order to enrol them to a risk adjusted primary prevention programme. This strategy resulted in a significant improvement of ESC-SCORE, as well as a reduction in predefined cardiovascular endpoints in the INT within 36 months. (ISRCTN 23536103.

Relation of N-terminal pro-B-type natriuretic peptide to symptoms, severity, and left ventricular remodeling in patients with organic mitral regurgitation

Natriuretic peptides reflect cardiac stress and may therefore be useful in the management of patients with valvular heart disease. Data regarding these biomarkers in organic mitral regurgitation (MR) are sparse. In this study, 144 patients with moderate or severe organic MR were prospectively enrolled in an observational, multicenter study to analyze the relation of N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) to symptoms, severity of MR, and echocardiographic parameters. NT-pro-BNP levels (median 373 pg/ml, interquartile range 150 to 997) were associated with age, gender, creatinine, New York Heart Association (NYHA) functional class, atrial fibrillation, left ventricular (LV) end-systolic dimension, and the LV ejection fraction. Independent predictors of increased NT-pro-BNP levels were NYHA functional class (p = 0.003), atrial fibrillation (p = 0.005) and LV end-systolic dimension (p = 0.029). MR severity and left atrial dimension were not independently associated with NT-pro-BNP levels. NT-pro-BNP levels increased significantly with NYHA class (p >0.001) but not with MR severity (p = 0.144). NT-pro-BNP levels were significantly higher in symptomatic patients than in asymptomatic patients (582 pg/ml [interquartile range 246-1,360] vs 157 pg/ml [interquartile range 64 to 256], p >0.0001). The area under the receiver-operating characteristic curve to predict symptoms for NT-pro-BNP was 0.80 (95% confidence interval 0.71 to 0.88), which was significantly higher than for all echocardiographic variables (p >0.001 for all). In conclusion, NYHA functional class, atrial fibrillation, and LV end-systolic dimension are independent predictors of increased NT-pro-BNP levels in patients with moderate or severe organic MR. Therefore, NT-pro-BNP may be helpful in the clinical evaluation and management of patients with MR, especially when it is doubtful whether symptoms are related to MR or not

S3 Guideline Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment - Short Version

Introduction: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. Methods: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. Results: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms. (C) 2022 S. Karger AG, Basel

German Guideline for Smoking and Tobacco Dependence: Screening, Diagnosis and Treatment, Update 2021 - Short Version

Introduction: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependance on tobacco products remains an important health-related task in Germany. Regular updating of the AWMF-S3Guideline,Smoking and Tobacco Dependence: Screening, Diagnosis and Treatment (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. Methods: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 people, who were involved in the development process of the text, in 11 working groups. Through careful COI management, the influence of conflicts of interest could be minimised. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. Results: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counselling and support services. If, due to the severity of the tobacco-related disorder, brief counselling, telephone counselling or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioural therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments or cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reaches a value of 98 %. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms