Kommentar zu den neuen Leitlinien (2021) der Europäischen Gesellschaft für Kardiologie (ESC) zur kardiovaskulären Prävention

The new ESC guidelines on cardiovascular disease prevention in clinical practice have introduced a number of new features into the guidelines: 1. The new SCORE2 system was developed based on recent European cohort studies with a total of 677,684 participants, a significant update compared to the old SCORE system, which was based on studies dating back to the 1970s and 1980s. For the first time SCORE2-OP enables the calculation of the individual risk in people> 69 years of age. SCORE2 also marks a change in the risk definition: instead of mortality risk it now provides an estimate of morbidity and mortality risks for cardiovascular diseases. 2. The thresholds for risk categorization based on SCORE2 are now dynamic with age: below 50 years of age individuals with a SCORE2 risk of ≥ 7.5% are very high-risk, while those between 50 and 69 years need to surpass ≥ 10% and those ≥ 70 years should be above 15% SCORE2 risk to be classified as very high risk. This change was made to reflect the lifetime exposure, which is greater at a younger age. 3. The novel 2‑step approach separates a general recommendation for prevention for all from the final prevention goals that should be reached in selected patients based on life years gained, comorbidities, frailty and patient wishes. There is a certain danger that this may dilute the prevention goals because many patients and physicians may not go beyond step 1. Not all effects of the new SCORE2 system and the readjusted risk thresholds have yet become clear. A close monitoring of how the new guidelines affect the number of patients in whom, e.g. statin treatment is recommended, is warranted in the different risk regions. Additionally, the freedom of choice with respect to prevention intensity remains a potential threat to optimal guideline implementation. Therefore, implementation studies are needed to continue the virtuous cycle of guideline development.