Secondary prevention of cardiovascular diseases: current state of the art

Prevention strategies for cardiac events depend of the risk for such an event. A very high risk is defined as a risk > 10% over 10 years. For example, a patient with known coronary artery disease has such a very high risk of death. However, a patient with diabetes and severe hypertension without known coronary artery disease carries the same risk. Here, secondary preven­tion and primary prevention overlap. Prevention guidelines include a number of general recommendations, such as changes in behaviour, nutrition, body weight, and physical activity as well as smoking intervention strategies. Drug treatment-based prevention strategies address diabetes mellitus, hypercholesterolaemia, platelet aggregation, and arterial hypertension. Follow­ing hospitalisation for heart failure or acute coronary syndrome, participation in a centre-based or home-based rehabilitation programme is recommended. There are a number of new treatment options with a promising potential to reduce the rate of events in patients with cardiovascular diseases and in patients with cardiovascular risk factors. Very recent treatment strategies include the PCSK9 inhibitors for hypercholesterolaemia and the SGLT2 inhibitors for reduction of cardiovascular events in patients with diabetes mellitus and increased cardiovascular risk