CoChat
Sign Up
Cited by 8,490Health Promotion and Cardiovascular PreventionClinical practice guidelines implementationCardiovascular Health and Risk Factors

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

Open access
Authors/Task Force Members:, Perk, Joep, De Backer, Guy, Gohlke, Helmut, Graham, Ian, Reiner, Željko, Verschuren, Monique, Albus, Christian +80 more·2012·European Heart Journal
DOI 10.1093/eurheartj/ehs092
Open this paper in CoChat — free accountOpen PDF

Abstract

nine societies and by invited experts)

Verified 2026-10-05 · 15 references not checked yet

Integrity signals

Registry

Crossref · 10.1093/eurheartj/ehs092

Cites

869 of 884 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 655 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    When evaluated with the AGREE instrument, only seven of the identified publications achieved a level considered considerable rigour.

    “When these were evaluated using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument, only seven achieved the level considered 'considerable rigour'.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Ferket, 2010, Systematic review of guidelines on cardiovascular risk assessment: which recommendations should clinicians follow for a cardiovascular health check?, Arch Intern Med source

      Not checked in the free run.

  • Findingreasoning

    In many MONICA centres there were substantial changes, up or down, in CVD events within periods as short as 10 years.

    “In many MONICA centres there were quite substantial changes, up or down, in CVD events within time periods as small as 10 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook

      Not checked in the free run.

  • Findingcitation

    The relationship between changes in risk factor scores and changes in event rates was substantial.

    “The relationship between changes in risk factor scores and changes in event rates was substantial.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook

      Not checked in the free run.

  • Findingcitation

    There was a significant association between treatment change and case fatality.

    “Moreover, there was a significant association between treatment change and case fatality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook

      Not checked in the free run.

  • Findingcitation

    Lipid control has improved significantly.

    “On the other hand, lipid control has improved significantly. 5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Kotseva, 2009, Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries, Lancet source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 100
  • May combine two claims. 237
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Of all deaths before age 75 in Europe, 42% in women and 38% in men are due to CVD.

    “of all deaths that occur before the age of 75 years in Europe, 42% are due to CVD in women and 38% in men.”
    • Also stated in: § 2.1 Scope of the problem · plain
      “CVD was responsible for 42% of all deaths below 75 years of age in European women and for 38% of all deaths at ,75 years in men.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] European Heart Network, 2008

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Beneficial reductions in major risk factors, particularly smoking, blood pressure, and cholesterol, accounted for more than half of the decrease in CHD deaths, although counteracted by increases in obesity and type 2 diabetes; 40% of the decline in CHD death rates is attributed to better treatments.

    “Beneficial reductions in major risk factors-in particular smoking, BP, and cholesterol-accounted for more than half of the decrease in CHD deaths, although they were counteracted by an increase in the prevalence of obesity and type 2 diabetes; 40% of the decline in CHD death rates is attributed to better treatments of acute myocardial infarction, heart failure, and other cardiac conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Ford, 2007, deaths from coronary disease, 1980–2000, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Changes in risk factors explained almost half the variation in event rates in men but less in women.

    “and the changes in risk factors explained almost half the variation in event rates in men but less in women.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The effect of lipid levels on risk is modest in women who are otherwise at low risk, and the risk advantage of being female is lost by the combination of smoking and mild hypertension.

    “The figure shows that the effect of the lipid levels on risk is modest in women who are at otherwise low risk, and that the risk advantage of being female is lost by the combination of smoking and mild hypertension.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Between EUROASPIRE I (1996) and EUROASPIRE III, the proportion of smokers did not change and blood pressure control did not improve despite increased use of antihypertensive drugs, while central obesity continued to increase.

    “Moreover, the changes between EUROASPIRE I (1996) and EUROASPIRE III reveal that the proportion of smokers did not change and BP control has not improved despite increased use of antihypertensive drugs, while the number of patients with (central) obesity continues to increase.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Kotseva, 2009, Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Fasting triglycerides relate to risk in univariate analyses, but the effect is attenuated by adjustment for other factors, especially HDL cholesterol.

    “Fasting triglycerides relate to risk in univariate analyses, but the effect is attenuated by adjustment for other factors, especially HDL cholesterol.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    CVD mortality has declined in many European countries, so more countries now fall into the low-risk category.

    “The fact that CVD mortality has declined in many European countries means that more countries now fall into the low-risk category.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The impact of diabetes on risk appears greater than in Framingham-based risk estimation systems, with relative risks of 5 in women and 3 in men.

    “While there is heterogeneity between cohorts, overall, the impact of diabetes on risk appears greater than in risk estimation systems based on the Framingham cohort, with relative risks of 5 in women and 3 in men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Five years later, at age 50, his risk increases to 14% over 10 years and he requires treatment.

    “Five years later, when he reaches 50 years, his risk increases into the danger zone of 14% over 10 years and he requires treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In the US Women's Health Initiative, only 4% of women had ideal cardiovascular health and 13% had no risk factors but failed to follow a healthy lifestyle.

    “In the US Women's Health Initiative, only 4% of women fell into this ideal state and a further 13% had no risk factors but failed to follow a healthy lifestyle.83”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] Hsia, 2010, Evaluation of the American Heart Association cardiovascular disease prevention guideline for women, Circ Cardiovasc Qual Outcomes source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Conflicts, crises, and long-term stressful conditions in family life increase CHD risk (HR 2.7-4.0), especially in women (RR 2.9-4.0).

    “Conflicts, crises, and long-term stressful conditions in family life have also been shown to increase CHD risk [hazard ratio (HR) 2.7 -4.0], especially in women (RR 2.9 -4.0).96,97”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [96] Eaker, 2007, Marital status, marital strain, and risk of coronary heart disease or total mortality: the Framingham Offspring Study, Psychosom Med source

      Not checked in the free run.

    • cites [97] Orth-Gomer, 2000, Marital stress worsens prognosis in women with coronary heart disease: the Stockholm Female Coronary Risk Study, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Perceived social support counteracts the adverse effect of depression, while lack of support reinforces it.

    “Perceived social support seems to counteract the adverse effect of depression, 103 whereas lack of support was found to reinforce its adverse effects.104”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [103] Frasure-Smith, 2000, Social support, depression, mortality during the first year after myocardial infarction, Circulation source

      Not checked in the free run.

    • cites [104] Horsten, 2000, Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Clinical depression and depressive symptoms predict incident CHD (RR 1.6 and 1.9) and worsen prognosis (OR 1.6 and 2.4).

    “Several systematic reviews and meta-analyses have shown that clinical depression and depressive symptoms predict incident CHD (RR 1.6 and 1.9), 98 -100 and worsen its prognosis (OR 1.6 and 2.4). 100 -102”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [98] Rugulies, 2002, Depression as a predictor for coronary heart disease. a review and meta-analysis, Am J Prev Med source

      Not checked in the free run.

    • cites [99] Wulsin, 2003, Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review, Psychosom Med source

      Not checked in the free run.

    • cites [100] Nicholson, 2006, Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies, Eur Heart J source

      Not checked in the free run.

    • cites [101] Barth, 2004, Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis, Psychosom Med source

      Not checked in the free run.

    • cites [102] van Melle, 2004, Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis, Psychosom Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    CVD is the major cause of death in women in all European countries; below 75 years, 42% of women die from CVD compared with 38% of men.

    “CVD is the major cause of death in women in all European countries; below 75 years, 42% of women die from CVD compared with 38% of men.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] European Heart Network, 2008

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two recent meta-analyses confirmed anxiety is an independent risk factor for incident CHD (HR 1.3) and for adverse events following myocardial infarction (OR 1.5 and 1.7).

    “However, two recent meta-analyses confirmed that anxiety is an independent risk factor for incident CHD (HR 1.3) 111 and for adverse events following myocardial infarction (OR 1.5 and 1.7, respectively).112”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [111] Roest, 2010, Anxiety and risk of incident coronary heart disease: a meta-analysis, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [112] Roest, 2010, Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis, Psychosom Med source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    There is limited evidence that routine screening for psychosocial risk factors contributes to fewer future cardiac events, as screening has not yet translated into improved healthcare models.

    “There is limited evidence that routine screening for psychosocial risk factors contributes to fewer future cardiac events, as screening has not yet translated into improved healthcare models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Recent meta-analyses have shown that symptoms of anxiety and type D personality increase risk for CVD and contribute to worse clinical outcome.

    “Recent meta-analyses have shown that symptoms of anxiety and the type D personality increase risk for CVD and contribute to worse clinical outcome.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The magnitude of homocysteine's effect on risk is modest, and consistency is often lacking, mainly due to nutritional, metabolic, and lifestyle confounders.

    “The magnitude of effect on risk is modest, and consistency is often lacking, mainly due to nutritional, metabolic (e.g.renal disease), and lifestyle confounders.128”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [128] Clarke, 2010, Effects of lowering homocysteine levels with B vitamins on cardiovascular disease, cancer, and cause-specific mortality: meta-analysis of 8 randomized trials involving 37 485 individuals, Arch Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Similar statements are made for fibrinogen.

    “Similar statements are made for fibrinogen.127”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] Kaptoge, 2007, Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies collaboration, Am J Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Simplification of treatment improves adherence to therapy.

    “Simplification of treatment improves adherence to therapy”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Calcium antagonists are effective in left ventricular hypertrophy and appear particularly beneficial in slowing progression of carotid hypertrophy and atherosclerosis.

    “calcium antagonists, besides being effective in LVH, appear particularly beneficial in slowing down progression of carotid hypertrophy and atherosclerosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Thiazide and thiazide-like diuretics, beta-blockers, calcium antagonists, ACE inhibitors, and angiotensin receptor antagonists can adequately lower blood pressure and significantly reduce cardiovascular morbidity and mortality.

    “thiazide and thiazide-like diuretics (chlorthalidone and indapamide), betablockers, calcium antagonists, ACE inhibitors, and angiotensin receptor antagonists can adequately lower BP, and significantly reduce risk of cardiovascular morbidity and mortality”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Aliskiren effectively lowers blood pressure in hypertension and has an antiproteinuric effect.

    “Aliskiren, which inhibits the effect of renin and pro-renin on their specific receptors, effectively lowers BP in hypertension 427 and has an antiproteinuric effect.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [427] Gradman, 2005, Aliskiren, a novel orally effective renin inhibitor provides dose-dependent antihypertensive efficacy placebo-like tolerability in hypertensive patients, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Vasodilating beta-blockers such as carvedilol and nebivolol have less or no dysmetabolic action and a reduced incidence of new-onset diabetes compared with conventional beta-blockers.

    “this may not apply to vasodilating beta-blockers such as carvedilol and nebivolol, which have less or no dysmetabolic action, as well as a reduced incidence of new-onset diabetes compared with conventional beta-blockers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    ACE inhibitors and angiotensin receptor antagonists are effective in reducing microalbuminuria and proteinuria and in preserving renal function and delaying end-stage renal disease.

    “they are also quite effective in reducing microalbuminuria and proteinuria and in preserving renal function and delaying end-stage renal disease”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Beta-blockers induce weight gain, have adverse effects on lipid metabolism, and increase the incidence of new-onset diabetes compared with other drugs.

    “as beta-blockers induce weight gain, have adverse effects on lipid metabolism, 395 and increase (compared with other drugs) the incidence of new-onset diabetes”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [395] Poulter, 2005, Role of blood pressure other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Alpha 1-blockers, centrally acting agents, and antialdosterone drugs effectively lower blood pressure.

    “Alpha 1 -blockers, centrally acting agents [alpa 2adrenoreceptor agonists and imidazoline (I 1 ) receptor agonists], and antialdosterone drugs effectively lower BP.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Hypertension is more common in patients with type 2 diabetes compared with the general population.

    “Hypertension is more common in patients with type 2 diabetes compared with the general population.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    The VADT found no significant difference between intensive and standard groups for any individual composite of the primary outcome or for all-cause mortality.

    “There was no significant difference between groups for any of the individual composites of the primary outcome or for all-cause mortality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [438] Duckworth, 2009, Glucose control and vascular complications in veterans with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The ACCORD trial was stopped prematurely at 3.5 years due to significantly increased total mortality in the intensive treatment group: 257 vs 203 (P=0.04) for deaths from any cause and 135 vs 94 (P=0.02) for cardiovascular deaths.

    “The trial was stopped prematurely at 3.5 years due to a significantly increased total mortality in the intensive treatment group: 257 vs. 203 (P ¼ 0.04) for deaths due to any cause and 135 vs. 94 (P ¼ 0.02) for deaths due to cardiovascular causes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [435] Patel, 2008, Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Post-trial monitoring of the UKPDS substudy showed no legacy effect, meaning intensive blood pressure control has to be maintained for continued benefit.

    “Post-trial monitoring of the UKPDS substudy showed no legacy effect (i.e.intensive BP control has to be maintained for continued benefit).426”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [426] Holman, 2008, Long-term follow-up after tight control of blood pressure in type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Weight gain and hypoglycaemia were less frequent in ADVANCE than in ACCORD.

    “Weight gain and hypoglycaemia were less frequent than in the ACCORD study.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [435] Patel, 2008, Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In ACCORD, there were significantly more cases of hypoglycaemia requiring assistance and significantly more weight gain in the intensive group.

    “There were significantly more cases of hypoglycaemia requiring assistance in the intensive group, who also experienced significantly more weight gain.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [435] Patel, 2008, Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In a UKPDS substudy, there was a marked significant 44% risk reduction for stroke and a non-significant 21% risk reduction for myocardial infarction associated with a 10 mmHg reduction in systolic blood pressure and a 5 mmHg reduction in diastolic blood pressure.

    “There was a marked and significant 44% risk reduction for stroke and a non-significant 21% risk reduction for myocardial infarction associated with a 10 mmHg reduction in SBP and a 5 mmHg reduction in DBP.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [441] UK Prospective Diabetes Study Group, 1998, Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Post-hoc analyses of ONTARGET, INVEST, and VALUE suggest that in high-risk hypertensive patients there may be no advantage or even harm in lowering systolic blood pressure below 130 mmHg, except perhaps for stroke.

    “Post-hoc analyses of large-scale trials (e.g.ONTARGET, INVEST, and VALUE), although suffering from the limitation posed by comparisons of nonrandomized groups, suggest that at least in high-risk hypertensive patients, there may be no advantage or even harm in lowering systolic BP below 130 mmHg, except perhaps for stroke.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites ONTARGET

      Not checked in the free run.

    • cites INVEST

      Not checked in the free run.

    • cites VALUE

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the UKPDS post-trial monitoring, the intensive treatment group had a 17% relative risk reduction in diabetes-related death (P=0.01), a 15% reduction in risk of myocardial infarction (P=0.01), and a 13% reduction in risk of death from any cause (P=0.007).

    “The intensive treatment group had a 17% relative risk reduction in diabetes-related death (P ¼ 0.01), a 15% reduction in risk of myocardial infarction (P ¼ 0.01), and a 13% reduction in risk of death from any cause (P ¼ 0.007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [444] Holman, 2008, 10-year follow-up of intensive glucose control in type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In the elderly, outcome trials have only addressed patients with an entry systolic blood pressure of at least 160 mmHg, and no trial achieved an average systolic blood pressure below 140 mmHg.

    “In the elderly, outcome trials have only addressed patients with an entry SBP ≥160 mmHg, and no trial achieved an average SBP ,140 mmHg.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    In diabetes, all major antihypertensive drug classes protect against cardiovascular complications, probably because of the protective effect of blood pressure lowering per se.

    “Meta-analyses of available trials show that, in diabetes, all major antihypertensive drug classes protect against cardiovascular complications, probably because of the protective effect of BP lowering per se.”
    • Also stated in: § 4.8.6 Blood pressure · hedged
      “Meta-analyses of available trials show that, in diabetes, all major antihypertensive drug classes protect against cardiovascular complications, probably because of the protective effect of BP lowering per se.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Post-hoc analyses indicate a progressive reduction in incidence of cardiovascular events with progressive lowering of systolic blood pressure down to 120 mmHg and diastolic blood pressure down to 75 mmHg, although additional benefit at low blood pressure values becomes small.

    “post-hoc analyses of trial data indicate a progressive reduction in incidence of cardiovascular events with progressive lowering of SBP down to 120 mmHg and DBP down to 75 mmHg, 412 although the additional benefit at low BP values becomes rather small.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [412] Lewington, 2002, Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In ADVANCE, intensive control significantly reduced the total number of major macrovascular events and major microvascular events, but only the reduction in microvascular events was statistically significant.

    “Intensive control significantly reduced the total number of major macrovascular events (death from cardiovascular causes, non-fatal myocardial infarction, nonfatal stroke) and major microvascular events (new or worsening nephropathy or retinopathy), but only the reduction in microvascular events was statistically significant.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [435] Patel, 2008, Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A meta-analysis of intensive glucose control including UKPDS, PROactive, ACCORD, ADVANCE, and VADT showed a significant reduction in non-fatal myocardial infarction and CHD events, but no effect on stroke or total mortality.

    “A meta-analysis of intensive glucose control including data from UKPDS, Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROactive), ACCORD, ADVANCE, and VADT 447 showed a significant reduction in non-fatal myocardial infarction and CHD events, but no effect on stroke or total mortality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [447] Ray, 2009, Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Intensive management of hyperglycaemia in diabetes reduces the risk of microvascular complications and, to a lesser extent, cardiovascular disease.

    “Intensive management of hyperglycaemia in diabetes reduces the risk of microvascular complications and, to a lesser extent, that of cardiovascular disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Aggressive control of hypertension and lowering cholesterol levels with statins reduce the risk of cardiovascular events.

    “Aggressive control of hypertension and lowering cholesterol levels with statins reduce the risk of cardiovascular events”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    A more recent meta-analysis excluding PROactive found a significant reduction in CHD and CVD events, but no reduction in cardiovascular mortality or total mortality.

    “A more recent meta-analysis examined trials of intensive vs. conventional glycaemic control, but did not include PROactive, and again identified the UKPDS, ACCORD, ADVANCE, and VADT trials.449 Similar results were found with a significant reduction in CHD and CVD events, but no reduction in cardiovascular mortality or total mortality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [449] Turnbull, 2009, Intensive glucose control and macrovascular outcomes in type 2 diabetes, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Heart Protection Study, the treatment effect was independent of baseline cholesterol, although absolute risk and treatment effect increased with rising cholesterol concentration.

    “The reactive treatment effect was independent of baseline cholesterol, although the absolute risk and treatment effect increased with rising cholesterol concentration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [436] Collins, 2003, MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The ACCORD BP study found no improvement in the primary endpoint, slight reductions in the secondary endpoint of strokes, and an increase in side effects with a lower target systolic blood pressure below 120 mmHg.

    “There was no improvement in the primary endpoint, with slight reductions in the secondary endpoint of strokes, and an increase in side effects with a lower target.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [451] Cushman, 2010, Effects of intensive blood-pressure control in type 2 diabetes mellitus, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The Steno-2 intensive multifactorial intervention significantly reduced the incidence of microvascular complications after 4 years and produced a significant 53% risk reduction in macrovascular complications after 8 years.

    “The benefit of the intensive multifactorial intervention was demonstrated by a significant reduction in the incidence of microvascular complications after 4 years, and a significant 53% risk reduction in macrovascular complications after 8 years.455”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [455] Gaede, 2003, Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Aspirin significantly reduced the risk of myocardial infarction in men, but not in women.

    “Aspirin significantly reduced the risk of myocardial infarction in men, but not in women.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [443] De Berardis, 2009, Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    ApoB can be substituted for LDL cholesterol but does not add further to risk assessment.

    “apoB can be substituted for LDL cholesterol, 475 but it does not add further to the risk assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [475] Thompson, 2006, Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies, J Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Hypertriglyceridaemia and low HDL cholesterol are independent CVD risk factors.

    “Hypertriglyceridaemia and low HDL cholesterol are independent CVD risk factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    ApoB is a similar risk marker to LDL cholesterol and a better index of the adequacy of LDL-lowering therapy.

    “it appears that apoB is a similar risk marker to LDL cholesterol and a better index of the adequacy of LDL-lowering therapy.476”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [476] McQueen, 2008, Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case–control study, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the HOT study, 75 mg of aspirin further reduced the risk of major cardiovascular events in well-controlled hypertensive patients with diabetes, but non-fatal major bleeds were significantly more common among patients receiving aspirin.

    “In the HOT study, 75 mg of aspirin further reduced the risk of major cardiovascular events in well-controlled hypertensive patients with diabetes, but non-fatal major bleeds were significantly more common among patients receiving aspirin.440”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [440] Hansson, 1998, Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    CVD remains a major cause of premature death in Europe, although mortality from it has fallen considerably in many European countries in recent decades.

    “It remains the major cause of premature death in Europe, even though CVD mortality has fallen considerably over recent decades in many European countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] European Heart Network, 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Global disability-adjusted life years lost to CVD are expected to rise from 85 million in 1990 to 150 million in 2020, remaining the leading somatic cause of productivity loss.

    “within the coming decades the disability-adjusted life years (DALYs) estimate is expected to rise from a loss of 85 million DALYs in 1990 to a loss of 150 million DALYs globally in 2020, thereby remaining the leading somatic cause of loss of productivity. 1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] SIGN (Scottish Intercollegiate Guidelines Network), 2007, Risk Estimation and the Prevention of Cardiovascular Disease. A National Clinical Guideline

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The level of evidence and strength of recommendation for particular treatment options were weighed and graded according to ESC recommendations.

    “The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to the ESC recommendations (Tables 1 and 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Statements disclosing conflicts of interest from the writing panel are available on the ESC website, and changes during the writing period were notified.

    “Statements from the writing panel disclosing conflicts of interest are available on the ESC website.Changes in conflicts of interest that arose during the writing period were notified.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GRADE may be used in conjunction with appraisals of resource use and cost-effectiveness.

    “and may also be used in conjunction with appraisals of resource use and cost-effectiveness.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Guyatt, 2008, What is ‘quality of evidence’ and why is it important to clinicians?, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Preparation and publication of the fifth JTF report was financially supported by the ESC without any involvement of the pharmaceutical industry.

    “The preparation and publication of the fifth JTF report was supported financially by the ESC without any involvement of the pharmaceutical industry.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The concept of primary and secondary prevention was replaced by recognition that atherosclerosis is a continuous process.

    “The concept of primary and secondary prevention was replaced by the recognition that atherosclerosis was a continuous process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Experts from nine organizations performed a comprehensive review and critical evaluation of diagnostic and therapeutic procedures, including assessment of the risk-benefit ratio.

    “In short, experts from the nine organizations performed a comprehensive review and a critical evaluation of diagnostic and therapeutic procedures, including assessment of the risk-benefit ratio.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    GRADE uses a transparent and rigorous process to assess quality of evidence in terms of whether further research would change confidence in estimates of intervention effects or diagnostic accuracy.

    “The JTF introduced GRADE as it uses a transparent and rigorous process to assess the quality of evidence in terms of whether further research would or would not change confidence in the estimate of intervention effects or diagnostic accuracy.10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Guyatt, 2008, What is ‘quality of evidence’ and why is it important to clinicians?, BMJ source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Because resources are valued differently across Europe, it is not feasible in these guidelines to make judgements about the appropriateness of resource use for the interventions and diagnostic strategies considered.

    “However, as resources are valued differently across Europe, it is not feasible in these guidelines to make judgements about the appropriateness of resource use for the interventions and diagnostic strategies considered here.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Once finalized, the document was submitted for extensive independent external review.

    “Once the document had been finalized by the fifth JTF experts it was submitted for extensive independent external review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    GRADE distinguishes quality of evidence from strength of recommendation, and strong evidence does not automatically lead to a strong recommendation.

    “GRADE also distinguishes quality of evidence and strength of recommendation.9 Strong evidence does not automatically lead to a strong recommendation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence strength of recommendations, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GRADE uses only two categories of recommendation: strong or weak (discretionary, conditional).

    “Rather than have a range of classes of recommendation (e.g.Class I-Class III), GRADE only uses two categories-strong or weak (i.e.discretionary, conditional).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Guyatt, 2008, GRADE: an emerging consensus on rating quality of evidence strength of recommendations, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atherosclerotic CVD, especially CHD, remains the leading cause of premature death worldwide.

    “Atherosclerotic CVD, especially CHD, remains the leading cause of premature death worldwide.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Schunemann, 2008, Grading quality of evidence and strength of recommendations for diagnostic tests and strategies, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    CVD mortality is changing, with declining age-standardized rates in most European countries, but rates remain high in Eastern Europe.

    “CVD mortality is changing, with declining age-standardized rates in most European countries, which remain high in Eastern Europe.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Levi, 2009, Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The document was published after revision and acceptance by the ESC Committee for Practice Guidelines and the co-operating organizations in the fifth JTF.

    “Following this revision and after acceptance by the ESC Committee for Practice Guidelines and the co-operating organizations in the fifth JTF, the document was published.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    GRADE is helpful for assessing evidence in CVD prevention because RCTs of health behaviours are difficult to conduct and may be misleading.

    “This is very helpful in assessing evidence for CVD prevention where RCTs of health behaviours are difficult to conduct and may be misleading.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The IMPACT model has been applied in different countries, and results are rather consistent and similar to other studies.

    “This model has been applied in different countries; the results from these studies are rather consistent and similar to what has been observed in other studies of the same subject, as summarized in Figure 1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Ford, 2007, deaths from coronary disease, 1980–2000, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Stroke is another substantial cause of death and disability.

    “The second major CVD-stroke-is another substantial cause of death and disability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The majority of CHD patients develop the disease at an advanced age, leading to compression of morbidity in the very old and prolonged life expectancy in good health.

    “The majority of these patients develop the disease at an advanced age, leading to a compression of morbidity in the very old of the community and to a prolonged life expectancy in good health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Since Geoffrey Rose, two approaches to CVD prevention are considered: the population strategy and the high-risk strategy.

    “Since the instruction by Geoffrey Rose decades ago, two approaches towards prevention of CVD are considered: the population strategy and the high-risk strategy.19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Rose, 1985, Sick individuals and sick populations, Int J Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The only reasonable explanation for these changes is that both environmental changes, especially related to lifestyle, and improved management are important.

    “The only reasonable explanation is that both environmental changes, especially related to lifestyle, and improved management are important.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    It was concluded that both primary prevention and treatment of cardiovascular events influence mortality.

    “Thus it was concluded that both primary prevention and treatment of cardiovascular events influence mortality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    In the high-risk approach, individuals targeted are more likely to benefit, but population impact is limited because people at such high risk are few.

    “Although individuals targeted in this strategy are more likely to benefit from the preventive interventions, the impact on the population level is limited, because people at such high risk are few.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prevention works: more than 50% of reductions in CHD mortality relate to changes in risk factors, and 40% to improved treatments.

    “Prevention works: .50% of the reductions seen in CHD mortality relate to changes in risk factors, and 40% to improved treatments.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Ford, 2007, deaths from coronary disease, 1980–2000, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The MONICA project indicated a heterogeneous trend in CHD incidence in Europe in the 1980s to 1990s.

    “Results from the Multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) project indicated a heterogeneous trend in CHD incidence in the 1980s to 1990s in Europe.16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A healthy lifestyle in the young is crucial, although ethical and other reasons prohibit strong randomized trial evidence for benefits of school health education or smoking cessation programmes.

    “Thus a healthy lifestyle in the young is crucial, although ethical and other reasons prohibit the provision of strong levels of evidence based on randomized trials for the benefits in terms of reduced incidence of CVD from, for example, school programmes on health education or smoking cessation actions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    CHD is now the leading cause of death worldwide, is on the rise, and has become a pandemic that respects no borders.

    “'Coronary heart disease (CHD) is now the leading cause of death worldwide; it is on the rise and has become a true pandemic that respects no borders'.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Schunemann, 2008, Grading quality of evidence and strength of recommendations for diagnostic tests and strategies, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    At present there is no standardized source of Europe-wide CVD morbidity data.

    “At present there is no standardized source of Europe-wide CVD morbidity data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Prevention in the young, the very old, or those with moderate or mild risk is still limited but can result in substantial benefit.

    “CVD prevention in the young, the very old, or those with just a moderate or mild risk is still limited, but can result in substantial benefit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent reports suggest that mortality and morbidity from CHD is levelling, especially in younger adults.

    “This pattern may have changed, and results from recent reports do suggest that mortality and morbidity from CHD is levelling, especially in younger adults.17,18”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] Ford, Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates, J Am Coll Cardiol 2007 source

      Not checked in the free run.

    • cites [18] Vander Stichele, 2008, Is the decline in coronary attack rates leveling off in Flanders?, Eur J Cardiovasc Prev Rehabil

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The population strategy may bring large benefits to the population although it may offer little to the individual.

    “The advantage is that it may bring large benefits to the population although it may offer little to the individual.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Despite gaps in understanding, there is ample evidence to justify intensive public health and individual preventive efforts.

    “Despite gaps in our understanding, there is ample evidence to justify intensive public health and individual preventive efforts.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Children are at very low absolute risk of CVD, but those at relatively high risk compared with peers remain at increased risk later in life because of tracking of risk factors.

    “Although children are at very low absolute risk of developing CVD, those at a relatively high risk compared with their peers remain at increased risk of experiencing a cardiovascular event later in life because of 'tracking' of risk factors”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Vos, 2003, Adolescent blood pressure and blood pressure tracking into young adulthood are related to subclinical atherosclerosis: the Atherosclerosis Risk in Young Adults (ARYA) study, Am J Hypertens source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The population strategy was long considered more cost-effective than the high-risk approach, but since the introduction of highly effective lipid-lowering drugs, improved smoking cessation programmes, and lower costs of antihypertensive drugs, the effectiveness of the high-risk approach has increased.

    “For a long time the population strategy has been considered to be more costeffective than the high-risk approach but since the introduction of highly effective lipid lowering drugs, improvement in smoking cessation programmes and lower costs of antihypertensive drugs, the effectiveness of the high risk approach has increased.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Manuel, 2006, Revisiting Rose: strategies for reducing coronary heart disease, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Europe, CVD remains a major cause of premature deaths and loss of DALYs.

    “In Europe, the burden remains high: CVD remains a major cause of premature deaths and loss of DALYs-a composite of premature death and living with the disease.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] European Heart Network, 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The distinction between primary and secondary prevention in CVD is arbitrary because atherosclerosis develops gradually.

    “Prevention is typically categorized as primary or secondary prevention, although in CVD the distinction between the two is arbitrary in view of the underlying, gradually developing atherosclerotic process.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Our understanding of the reasons for changes in behaviour of populations and individuals remains incomplete.

    “Our understanding of the reasons for changes in the behaviour of both populations and individuals remains incomplete.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Although clinicians often ask for threshold values to trigger intervention, this is problematic because risk is a continuum and there is no exact point above which a drug is automatically indicated, nor below which lifestyle advice may not usefully be offered.

    “Although clinicians often ask for threshold values at which to trigger an intervention, this is problematic since risk is a continuum and there is no exact point above which, for example, a drug is automatically indicated, nor below which lifestyle advice may not usefully be offered.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    The choice of CVD mortality rather than total (fatal + nonfatal) events in SCORE was deliberate although not universally popular.

    “The choice of CVD mortality rather than total (fatal + nonfatal) events was deliberate although not universally popular.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    All risk estimation systems are relatively crude and require attention to qualifying statements.

    “All risk estimation systems are relatively crude and require attention to qualifying statements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Persons with established CVD are already at very high risk of further events and need prompt intervention on all risk factors.

    “As noted in the 'priorities' section, persons with established CVD are already at very high risk of further events and need prompt intervention on all risk factors”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Patients who have had a clinical event such as an acute coronary syndrome or stroke automatically qualify for intensive risk factor evaluation and management.

    “Patients who have had a clinical event such as an acute coronary syndrome (ACS) or stroke automatically qualify for intensive risk factor evaluation and management.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The implication that total risk assessment is associated with improved clinical outcomes compared with other strategies has not been adequately tested.

    “Having said that, the implication that total risk assessment, while logical, is associated with improved clinical outcomes when compared with other strategies has not been adequately tested.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The potential for prevention based on healthy lifestyles, appropriate management of classical risk factors, and selective use of cardioprotective drugs is obvious.

    “The potential for prevention based on healthy lifestyles, appropriate management of classical risk factors, and selective use of cardioprotective drugs is obvious.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    In younger persons, a low absolute risk may conceal a very high relative risk, and use of the relative risk chart or calculation of risk age may help advise them of the need for intensive lifestyle efforts.

    “In younger persons, a low absolute risk may conceal a very high relative risk, and use of the relative risk chart or calculation of their 'risk age' may help in advising them of the need for intensive lifestyle efforts.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many committees from other countries have almost the same views as NICE.

    “and many committees from other countries have almost the same views.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Kotseva, 2009, EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    A risk estimation system such as SCORE can assist in making logical management decisions and may help avoid both under- and overtreatment.

    “A risk estimation system such as SCORE can assist in making logical management decisions, and may help to avoid both under-and overtreatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 2003 guidelines used the SCORE chart for risk estimation, which was based on data from 12 European cohort studies; it included 205,178 subjects examined at baseline between 1970 and 1988 with 2.7 million years of follow-up and 7934 cardiovascular deaths.

    “The 2003 guidelines 44 used the SCORE chart for risk estimation, 45 which was based on data from 12 European cohort studies; it included 205 178 subjects examined at baseline between 1970 and 1988 with 2.7 million years of follow-up and 7934 cardiovascular deaths.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Conroy, 2003, Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project, Eur Heart J source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    The SCORE system estimates the 10-year risk of a first fatal atherosclerotic event, whether heart attack, stroke, aneurysm of the aorta, or other.

    “The SCORE system estimates the 10-year risk of a first fatal atherosclerotic event, whether heart attack, stroke, aneurysm of the aorta, or other.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The multiplier to convert fatal to total CVD is unstable and often less than clinicians expect because follow-up ends at the first event and subsequent events are not counted.

    “The multiplier to convert fatal to total CVD is similarly unstable and is often less than clinicians expect, since follow-up is terminated in all current systems with the first event, and subsequent fatal or non-fatal events are not counted.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Risk charts such as SCORE are intended to facilitate risk estimation in apparently healthy persons.

    “Risk charts such as SCORE are intended to facilitate risk estimation in apparently healthy persons.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    While women appear to be at lower CVD risk than men, this is misleading because risk is deferred by 10 years rather than avoided.

    “While women appear to be at lower CVD risk than men, this is misleading as risk is deferred by 10 years rather than avoided.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    While the ideal scenario would be for all adults to have their risk of CVD assessed, this may not be practicable for many societies.

    “While the ideal scenario would be for all adults to have their risk of CVD assessed, this may not be practicable for many societies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    'Total risk' is not comprehensive because the effects of other risk factors are not considered except as qualifying statements.

    “The term has become widely used; however, 'total risk' is not comprehensive because the effects of other risk factors are not considered except as qualifying statements.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Any risk estimation system will overpredict in countries in which mortality has fallen and underpredict in those in which it has risen.

    “Any risk estimation system will overpredict in countries in which mortality has fallen and underpredict in those in which it has risen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Women and old and young subjects have been underrepresented in the classic drug trials that have informed guidelines to date.

    “In general, women and old and young subjects have been underrepresented in the classic drug trials that have informed guidelines to date.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Most people will visit their family doctor at least once over a 2-year period, giving an opportunity for risk assessment.

    “Most people will visit their family doctor at least once over a 2-year period giving an opportunity for risk assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The total risk approach allows flexibility: if perfection cannot be achieved with one risk factor, risk can still be reduced by trying harder with others.

    “The total risk approach allows flexibility: if perfection cannot be achieved with one risk factor, risk can still be reduced by trying harder with others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The 20% total CVD or CHD risk used to denote high risk in many guidelines is likely variable, unstable over time, and hard to validate.

    “Thus, the '20% total CVD (or CHD)' risk used to denote high risk in many guidelines is likely to be variable, unstable over time, and hard to validate.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Additional factors affecting risk can be accommodated in electronic risk estimation systems such as HeartScore.

    “Additional factors affecting risk can be accommodated in electronic risk estimation systems such as HeartScore (www.heartscore.org).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Individuals at the highest levels of risk gain most from risk factor management.

    “As such, they acknowledge that individuals at the highest levels of risk gain most from risk factor management.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Certain individuals are at high CVD risk without needing risk scoring and require immediate intervention for all risk factors.

    “Certain individuals are at high CVD risk without needing risk scoring and require immediate intervention for all risk factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Death is a hard and reproducible endpoint, whereas non-fatal events are variable and depend on definitions, diagnostic criteria, and diagnostic tests that may vary over time.

    “Death is a hard and reproducible endpoint; a non-fatal event is variable and depends upon definitions, diagnostic criteria, and diagnostic tests, all of which may vary over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Most other risk estimation systems estimate CHD risk only.

    “Most other systems estimate CHD risk only.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Striking changes in both diagnostic tests and therapies have occurred since the SCORE cohorts were assembled.

    “Striking changes in both diagnostic tests and therapies have occurred since the SCORE cohorts were assembled.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    All elderly people will eventually be at high risk of death and may be overexposed to drug treatments.

    “and the fact that all elderly people will eventually be at high risk of death and may be overexposed to drug treatments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    It is uncertain whether CVD is merely deferred by preventive efforts or can be avoided completely.

    “It is uncertain whether CVD is merely deferred by preventive efforts or if it of can be avoided completely.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    For these reasons, CVD mortality charts were produced and have been re-calibrated for a number of European countries.

    “For these reasons, the CVD mortality charts were produced, and have been re-calibrated for a number of European countries.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    In SCORE, accounting for family history is probably very crude and most certainly an underestimate.

    “In SCORE, accounting for family history is probably very crude and is most certainly an underestimate.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increasing age and male sex increase CVD risk and are fixed characteristics used to stratify risk assessments.

    “Increasing age and male sex increase CVD risk and are 'fixed' characteristics used to stratify risk assessments.45”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Conroy, 2003, Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project, Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Even the high-risk charts may underestimate risk in very-high-risk countries.

    “Even the high-risk charts may underestimate risk in these countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The higher the risk, the greater the benefit from preventive efforts.

    “The higher the risk the greater the benefit from preventive efforts, which guides the following priorities:”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Family history is a variable combination of genetics and shared environment.

    “Family history is a variable combination of genetics and shared environment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Risk age can be used in any population regardless of baseline risk and secular changes in mortality, avoiding re-calibration.

    “Risk age can be used in any population regardless of baseline risk and of secular changes in mortality, and therefore avoids the need for re-calibration.68”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] Cuende, 2010, How to calculate vascular age with the SCORE project scales: a new method of cardiovascular risk evaluation, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Risk will be overestimated in countries with falling CVD mortality and underestimated in countries with increasing mortality.

    “Risk will be overestimated in countries with a falling CVD mortality, and underestimated in countries in which mortality is increasing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Many lifestyle measures are less amenable to RCT assessment than drug treatments, so they tend to receive a higher grade.

    “While this is appropriate, many lifestyle measures are less amenable to such assessment than are drug treatments, which will therefore tend to receive a higher grade.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    National re-calibrations likely better represent current risk levels.

    “Such charts are likely to better represent current risk levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Risk may be higher than indicated in charts in sedentary subjects and those with central obesity; the increased risk associated with overweight is greater in younger subjects.

    “Sedentary subjects and those with central obesity; these characteristics determine many of the other aspects of risk listed below.The increased risk associated with overweight is greater in younger subjects than in older subjects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    In very-high-risk countries, the male:female ratio is smaller than in low-risk countries, suggesting a major problem for women.

    “low-risk countries, suggesting a major problem for women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    The risk of CVD in women, as in men, can be reduced by not smoking, being active, avoiding overweight, and having blood pressure and blood cholesterol checked and treated if elevated.

    “The risk of CVD in women, as in men, can be reduced by not smoking, by being active, avoiding overweight, and by having a blood pressure and blood cholesterol check (and intervention, if elevated).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Risk rises with increasing blood sugar concentration before overt diabetes occurs.

    “Risk rises with increasing blood sugar concentration before overt diabetes occurs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Current systems of grading evidence give most weight to RCTs.

    “Current systems of grading evidence give most weight to RCTs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Risk may be higher than indicated in charts in individuals with low HDL, increased triglycerides, fibrinogen, apoB, Lp(a), especially with familial hypercholesterolaemia, and perhaps increased hsCRP.

    “Individuals with low HDL cholesterol, increased triglycerides, fibrinogen, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)] levels, especially in combination with familial hypercholesterolaemia, and perhaps increased high-sensitivity CRP (hsCRP).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The young, women, older people, and ethnic minorities continue to be under-represented in clinical trials.

    “The young, women, older people, and ethnic minorities continue to be under-represented in clinical trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    CVD is by far the biggest cause of death in women.

    “CVD is by far the biggest cause of death in women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Similar considerations apply in women who are at lower absolute risk at younger ages and may have high levels of specific risk factors.

    “Similar considerations apply in women who are at lower absolute risk at younger ages and may have high levels of specific risk factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Investment in additional measurements such as CT coronary calcium may be helpful but adds cost and time, and its benefit remains unproven.

    “Investment in additional measurements such as imaging with computed tomography to obtain coronary calcium scores may be helpful, 79 but adds considerably to the cost and time involved in risk factor scoring, and its benefit remains unproven.80”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [79] Schisterman, 2004, Coronary age as a risk factor in the modified Framingham risk score, BMC Med Imaging source

      Not checked in the free run.

    • cites [80] Weintraub, 2008, Predicting cardiovascular events with coronary calcium scoring, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    CVD mortality does not accelerate in women following menopause, indicating women postpone risk rather than avoid it.

    “CVD mortality does not accelerate in women following the menopause, indicating that women are postponing their risk rather than avoiding it altogether.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Asymptomatic women and older people benefit from risk scoring to determine management.

    “Asymptomatic women and older people benefit from risk scoring to determine management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mechanisms linking psychosocial factors to increased CVD risk include unhealthy lifestyle, increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.

    “Mechanisms that link psychosocial factors to increased CVD risk include unhealthy lifestyle (more frequent smoking, unhealthy food choice, and less physical exercise), increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.88,90,116 -119”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [88] Stringhini, 2010, Association of socioeconomic position with health behaviors and mortality, JAMA source

      Not checked in the free run.

    • cites [90] Albert, 2006, Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events, Circulation source

      Not checked in the free run.

    • cites [116] Wamala, 1999, Potential explanations for the educational gradient in coronary heart disease: a population-based case–control study of Swedish women, Am J Public Health source

      Not checked in the free run.

    • cites [117] Chandola, 2008, Work stress and coronary heart disease: what are the mechanisms?, Eur Heart J source

      Not checked in the free run.

    • cites [118] Rozanski, 2005, The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [119] Whooley, 2008, Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    MRI is a promising research tool, but its routine use remains limited and it is not yet appropriate for identifying patients at high risk for CVD.

    “At present, MRI is a promising research tool, but its routine use remains limited and it is not yet appropriate for identifying patients at high risk for CVD.146”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [146] Greenland, 2000, Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    LpPLA2 is an independent risk factor for plaque rupture and atherothrombotic events, with high consistency and precision.

    “LpPLA2 has recently emerged as a marker with high consistency and precision as an independent risk factor for plaque rupture and atherothrombotic events.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [129] Garza, 2007, Association between lipoprotein-associated phospholipase A2 and cardiovascular disease: a systematic review, Mayo Clin Proc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Agatston score is an independent risk marker regarding the extent of CHD and prognostic impact.

    “The Agatston score is an independent risk marker regarding the extent of CHD 157 and prognostic impact.158”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [157] Hecht, 2001, Electron beam tomography and National Cholesterol Education Program guidelines in asymptomatic women, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [158] Hadamitzky, 2009, Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease, JACC Cardiovasc Imaging source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The effect of LpPLA2 on risk at the general population level is modest, and study limitations or bias are present.

    “The magnitude of effect on risk remains modest at the level of the general population; study limitations or bias are present.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Significant stenosis without coronary calcium is more likely in unstable angina or NSTEMI than in stable chest pain, and occurs more frequently in younger patients.

    “It is more likely in the setting of unstable angina or non-ST elevation myocardial infarction (NSTEMI) than in stable chest pain, and occurs more frequently in younger patients.155”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [155] Marwan, 2009, Clinical characteristics of patients with obstructive coronary lesions in the absence of coronary calcification: an evaluation by coronary CT angiography, Heart source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    No more than mandatory education and/or a yes for one or more items indicates a higher risk than that assessed with SCORE tools or priority categories.

    “No more than mandatory education and/or a 'yes' for one or more items indicates a higher risk than that assessed with the SCORE tools or priority categories.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    This variation in disease is probably due to genetic susceptibility, combinations of different risk factors, and interactions between genetic and environmental factors.

    “This variation in disease is probably due to genetic susceptibility, combinations of different risk factors, and interactions between genetic and environmental factors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Atherosclerosis is an inflammatory disease in which immune mechanisms interact with metabolic risk factors to initiate, propagate, and activate lesions in the arterial tree.

    “Atherosclerosis is an inflammatory disease in which immune mechanisms interact with metabolic risk factors to initiate, propagate, and activate lesions in the arterial tree.170”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [170] Hansson, 2005, Inflammation, atherosclerosis, and coronary artery disease, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    CVD risk is increased at an early stage of rheumatoid arthritis, and this risk excess beyond traditional risk parameters is possibly related to systemic inflammation and a prothrombotic state.

    “CVD risk is increased at an early stage of the disease, and this risk excess beyond traditional risk parameters is possibly related to systemic inflammation and a prothrombotic state.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Patients in whom psoriasis was classified as severe had a higher risk of myocardial infarction than patients with mild psoriasis, consistent with the hypothesis that greater immune activity in psoriasis is related to a higher risk of myocardial infarction and cardiovascular death.

    “Patients in whom the psoriasis was classified as severe had a higher risk of myocardial infarction than patients with mild psoriasis, consistent with the hypothesis that greater immune activity in psoriasis is related to a higher risk of myocardial infarction and cardiovascular death.185,186”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [185] Gelfand, 2006, Risk of myocardial infarction in patients with psoriasis, JAMA source

      Not checked in the free run.

    • cites [186] Mehta, 2010, Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Periodontitis is associated with endothelial dysfunction, atherosclerosis, and an increased risk of myocardial infarction and stroke.

    “Periodontitis is associated with endothelial dysfunction, atherosclerosis, and an increased risk of myocardial infarction and stroke.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Plaques are related to both coronary obstructive disease and the risk of cerebrovascular events.

    “Plaques are related to both coronary obstructive disease and the risk of cerebrovascular events.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Lipid lowering appears useful in a wide range of patients with advanced CKD but with no known history of myocardial infarction or coronary revascularization: a reduction of LDL cholesterol by 0.85 mmol/L with daily 20 mg simvastatin plus 10 mg ezetimibe reduced the incidence of major events.

    “Lipid lowering appears useful in a wide range of patients with advanced CKD but with no known history of myocardial infarction or coronary revascularization: a reduction of low-density lipoprotein (LDL) cholesterol by 0.85 mmol/L (33 mg/dL) with daily 20 mg simvastatin plus 10 mg ezetimibe reduced the incidence of major events”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [174] Baigent, 2011, The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Inflammatory mediators and promoters of calcification are increased and inhibitors of calcification are reduced in CKD, which favours vascular calcification and vascular injury.

    “Inflammatory mediators and promoters of calcification are increased and inhibitors of calcification are reduced in CKD, which favours vascular calcification and vascular injury.136”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [136] Schiffrin, 2007, Chronic kidney disease: effects on the cardiovascular system, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The place of ophthalmoscopy in vascular disease risk assessment remains uncertain.

    “However, its place in vascular disease risk assessment remains uncertain.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Systemic lupus erythematosus is associated with endothelial dysfunction and an increased risk of CHD that is not fully explained by classic CHD risk factors.

    “Systemic lupus erythematosus is associated with endothelial dysfunction and an increased risk of CHD that is not fully explained by classic CHD risk factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ED afflicts to some degree 52% of male adults between the ages of 40 and 70 years.

    “Erectile dysfunction (ED), defined as the consistent inability to reach and maintain an erection satisfactory for sexual activity, afflicts to some degree 52% of male adults between the ages of 40 and 70 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Coronary microvascular dysfunction is an early marker of accelerated coronary atherosclerosis and may contribute to the increased cardiovascular morbidity and mortality in patients with systemic lupus erythematosus.

    “Coronary microvascular dysfunction is an early marker of accelerated coronary atherosclerosis and may contribute to the increased cardiovascular morbidity and mortality in these patients.189”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [189] Recio-Mayoral, 2009, Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease, Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    OSA affects an estimated 9% of adult women and 24% of adult men.

    “It affects an estimated 9% of adult women and 24% of adult men.175”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [175] Young, 1993, The occurrence of sleep-disordered breathing among middle-aged adults, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    IMT is a measurement not only of early atherosclerosis but also of smooth muscle hypertrophy/hyperplasia, which may be related to genetic factors, hypertension, and age-related sclerosis.

    “The IMT is a measurement not only of early atherosclerosis but also of smooth muscle hypertrophy/hyperplasia, which may be related even to genetic factors, hypertension, and age-related sclerosis.132”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [132] Sramek, 2000, Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries, Invest Radiol source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    The risk of myocardial infarction associated with psoriasis is greatest in young patients with severe psoriasis, is attenuated with age, and remains increased even after controlling for traditional cardiovascular risk factors.

    “The risk of myocardial infarction associated with psoriasis is greatest in young patients with severe psoriasis, is attenuated with age, and remains increased even after controlling for traditional cardiovascular risk factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    ED is a marker for CVD and a predictor of future events in middle-aged and older men but not beyond that offered by the Framingham risk score.

    “ED is a marker for CVD and a predictor of future events in middle-aged and older men but not beyond that offered by the Framingham risk score.182 -184”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [182] Feldman, 2000, Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study, Prev Med source

      Not checked in the free run.

    • cites [183] Jackson, 2006, Erectile dysfunction: a marker of silent coronary artery disease, Eur Heart J source

      Not checked in the free run.

    • cites [184] Araujo, 2010, Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score?, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Patients with rheumatoid arthritis have a higher mortality rate after myocardial infarction, which may only partially explain their reduced life expectancy (5-10 years shorter than patients without the condition).

    “They also have a higher mortality rate after myocardial infarction, which may only partially explain their reduced life expectancy (5-10 years shorter than patients without the condition).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    An ABI value indicating significant PAD adds additional value to medical history, because 50-89% of patients with an ABI <0.9 do not have typical claudication.

    “An ABI value indicating significant PAD adds additional value to medical history, because 50 -89% of patients with an ABI ,0.9 do not have typical claudication.134”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [134] McDermott, 2002, The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    There is a graded increase in cardiovascular risk with rising IMT, and a value >0.9 mm is considered abnormal.

    “Although there is a graded increase in cardiovascular risk with rising IMT, a value .0.9 mm is considered abnormal.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Periodontitis can be considered a risk indicator for a generally decreased cardiovascular health status and its treatment is indicated as well as management of the underlying cardiovascular risk factors.

    “Periodontitis can be considered a risk indicator for a generally decreased cardiovascular health status and its treatment is indicated as well as management of the underlying cardiovascular risk factors.190”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [190] Tonetti, 2007, Treatment of periodontitis and endothelial function, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk increases to four- to 10-fold in stage 4 and to 10- to 50-fold in stage 5 renal failure.

    “The risk increases to four-to 10-fold in stage 4 (GFR 15 -29 mL/min/1.73m 2 ) and to 10-to 50-fold in stage 5 renal failure (end-stage) (GFR ,15 mL/min/ 1.73 m 2 or dialysis).136”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [136] Schiffrin, 2007, Chronic kidney disease: effects on the cardiovascular system, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The relative risk for events is slightly lower after statistical correction for traditional risk factors, but the risk remains elevated at higher IMT.

    “Although the relative risk for events is slightly lower after statistical correction for the presence of traditional risk factors, the risk remains elevated at higher IMT.130”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [130] O'Leary, 1999, Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The extent of carotid IMT is an independent predictor of cerebral and coronary events, but seems to be more predictive in women than in men.

    “The extent of carotid IMT is an independent predictor of cerebral and coronary events, but seems to be more predictive in women than in men.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The extent of retinal artery atherosclerosis correlates with the extent of coronary artery atherosclerosis and with serum levels of cholesterol, triglycerides, and apoB.

    “It has been shown that the extent of retinal artery atherosclerosis correlates with the extent of coronary artery atherosclerosis and with serum levels of cholesterol, triglycerides, and apoB.164”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [164] Tedeschi-Reiner, 2004, Atherosclerosis of retinal arteries in men: role of serum lipoproteins and apoproteins, Croat Med J

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Duration also plays a role, and all types of smoked tobacco, including low-tar, filter cigarettes, cigars, and pipes, are harmful.

    “Duration also plays a role, and, while cigarette smoking is the most common, all types of smoked tobacco, including low-tar ('mild' or 'light') cigarettes, filter cigarettes, cigars, and pipes, are harmful.211”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [211] Center for Disease Control and Prevention, 2010, How Tobacco Smoke Causes Disease: The Biology and Behavioural Basis for Smoking-attributable Disease

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Administration of statins improves endothelial dysfunction, slows the development of cardiac allograft vasculopathy, and benefits survival.

    “Administration of statins improves endothelial dysfunction, slows the development of cardiac allograft vasculopathy, and benefits survival.194”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [194] Hunt, 2008, The changing face of heart transplantation, J Am Coll Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Individuals of low socio-economic status, of older age, or female gender may need tailored programmes in order to meet their specific needs regarding information and emotional support.

    “Individuals of low socio-economic status, of older age, or female gender may need tailored programmes in order to meet their specific needs regarding information and emotional support.202,206”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [202] Artinian, 2010, Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association, Circulation source

      Not checked in the free run.

    • cites [206] Burell, 2002, Women's hearts need special treatment, Int J Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Smoking is an established cause of a plethora of diseases and is responsible for 50% of all avoidable deaths in smokers, half of these due to CVD.

    “Smoking is an established cause of a plethora of diseases and is responsible for 50% of all avoidable deaths in smokers, half of these due to CVD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Although the rate of smoking is declining in Europe, it is still very common among individuals who have received little education; and widening education-related inequalities in smoking-cessation rates have been observed in many European countries in recent years.

    “Although the rate of smoking is declining in Europe, it is still very common among individuals who have received little education; and widening education-related inequalities in smoking-cessation rates have been observed in many European countries in recent years.214,216,217”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [214] Edwards, 2004, The problem of tobacco smoking, BMJ source

      Not checked in the free run.

    • cites [216] Huisman, 2005, Inequalities in the prevalence of smoking in the European Union: comparing education and income, Prev Med source

      Not checked in the free run.

    • cites [217] Giskes, 2005, Trends in smoking behaviour between 1985 and 2000 in nine European countries by education, J Epidemiol Community Health source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Increased awareness of these factors facilitates empathy and counselling, thus facilitating behavioural change.

    “Increased awareness of these factors facilitates empathy and counselling (simple and explicit advice), thus facilitating behavioural change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    A friendly and positive interaction is a powerful tool to enhance an individual's ability to cope with illness and adhere to recommended lifestyle changes and medication use.

    “A friendly and positive interaction is a powerful tool to enhance an individual's ability to cope with illness and adhere to recommended lifestyle changes and medication use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Reactive oxygen species present in inhaled smoke cause oxidation of plasma LDL; oxidized LDL triggers the inflammatory process in the intima through stimulation of monocyte adhesion to the vessel wall, resulting in increased atherosclerosis.

    “Reactive oxygen speciesfree radicals-present in inhaled smoke cause oxidation of plasma LDL; oxidized LDL triggers the inflammatory process in the intimae of the arteries through stimulation of monocyte adhesion to the vessel wall, resulting in increased atherosclerosis.232,239 -242”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [232] Yamaguchi, 2001, Oxidants in cigarette smoke extract modify low-density lipoprotein in the plasma and facilitate atherogenesis in the aorta of Watanabe heritable hyperlipidemic rabbits, Atherosclerosis source

      Not checked in the free run.

    • cites [239] Weber, 1996, Increased adhesiveness of isolated monocytes to endothelium is prevented by vitamin C intake in smokers, Circulation source

      Not checked in the free run.

    • cites [240] Weber, 1995, Enhancement of monocyte adhesion to endothelial cells by oxidatively modified low-density lipoprotein is mediated by activation of CD11b, Biochem Biophys Res Commun source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Smoking enhances both the development of atherosclerosis and the occurrence of superimposed thrombotic phenomena.

    “it is clear that smoking enhances both the development of atherosclerosis and the occurrence of superimposed thrombotic phenomena.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    These factors impede the ability to adopt a healthy lifestyle, as does complex or confusing advice from medical caregivers.

    “In addition, these factors impede the ability to adopt a healthy lifestyle, as does complex or confusing advice from medical caregivers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the EUROASPIRE III survey, 30% of participants were smokers up to the time of their coronary event and this had dropped by one-half after a median of 1.5 years; evidence-based treatment for smoking cessation was underused.

    “In the EUROASPIRE III survey 30% of the participants were smokers up to the time of their coronary event and this had dropped by one-half after a median of 1.5 years.The survey also found that evidence-based treatment for smoking cessation was underused.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Kotseva, 2009, EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Social support provided by caregivers may be of importance in helping individuals maintain healthy habits and follow medical advice.

    “Social support provided by caregivers may be of importance in helping individuals maintain healthy habits and follow medical advice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    These patterns are framed during childhood and adolescence by an interaction of environmental and genetic factors, and are maintained or even promoted by the individual's social environment as an adult.

    “These patterns are framed during childhood and adolescence by an interaction of environmental and genetic factors, and are maintained or even promoted by the individual's social environment as an adult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    Marked differences in health behaviour between individuals but also between social groups can be observed.

    “Consequently, marked differences in health behaviour between individuals but also between social groups can be observed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Lifestyle is usually based on long-standing behavioural patterns.

    “'Lifestyle' is usually based on long-standing behavioural patterns.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Moving forward in small, consecutive steps is one of the key points in changing long-term behaviour.

    “Moving forward in small, consecutive steps is one of the key points in changing long-term behaviour.202”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [202] Artinian, 2010, Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Goal setting combined with self-monitoring of the chosen behaviour are the main tools needed to achieve a positive outcome.

    “goal setting combined with selfmonitoring of the chosen behaviour are the main tools needed to achieve a positive outcome.202”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [202] Artinian, 2010, Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Previous negative, unsuccessful attempts to change behaviour often result in a lower self-efficacy for future change and often lead to another failure.

    “Previous negative, unsuccessful attempts to change behaviour often result in a lower self-efficacy for future change and often lead to another failure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Individualized counselling is the basis for evoking and gaining the patient's motivation and commitment.

    “Individualized counselling is the basis for evoking and gaining the patient's motivation and commitment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The risk associated with smoking is primarily related to the amount of tobacco smoked daily and shows a clear dose-response relationship with no lower limit for deleterious effects.

    “The risk associated with smoking is primarily related to the amount of tobacco smoked daily and shows a clear dose-response relationship with no lower limit for deleterious effects.220”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [220] Prescott, 2002, Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study, J Epidemiol Community Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These interventions enhance coping with illness, and improve adherence with prescribed medication, efforts to change behaviour, and cardiac outcome.

    “They enhance coping with illness, and improve adherence with prescribed medication, efforts to change behaviour, and cardiac outcome.195,197,198”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [195] Dusseldorp, 1999, A meta-analysis of psychoeduational programs for coronary heart disease patients, Health Psychol source

      Not checked in the free run.

    • cites [197] Clark, 2005, Meta-analysis: secondary prevention programs for patients with coronary artery disease, Ann Intern Med source

      Not checked in the free run.

    • cites [198] Auer, 2008, Efficacy of in-hospital multidimensional interventions of secondary prevention after acute coronary syndrome: a systematic review and meta-analysis, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mechanisms point towards the effect of smoking on endothelial function, oxidative processes, platelet function, fibrinolysis, inflammation, and modification of lipids and vasomotor function.

    “Mechanisms have been elucidated through observational cohort studies, experimental observations, and laboratory studies in humans and animals, 225,227 -229 and point towards the effect of smoking on endothelial function, 230,231 oxidative processes, 232 platelet function, 233 fibrinolysis, inflammation, 234 -238 and modification of lipids and vasomotor function.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [225] Raupach, 2006, Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm, Eur Heart J source

      Not checked in the free run.

    • cites [227] Ambrose, 2004, The pathophysiology of cigarette smoking and cardiovascular disease: an update, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [228] Armani, 2009, Molecular and biochemical changes of the cardiovascular system due to smoking exposure, Curr Pharm Des source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    While the relative risk of myocardial infarction in smokers >60 years of age is doubled, the relative risk in smokers <50 years is five-fold higher than in non-smokers.

    “However, while the relative risk of myocardial infarction in smokers .60 years of age is doubled, the relative risk in smokers ,50 years is five-fold higher than in non-smokers.214,215”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [214] Edwards, 2004, The problem of tobacco smoking, BMJ source

      Not checked in the free run.

    • cites [215] Prescott, 1998, Smoking and risk of myocardial infarction in women and men: longitudinal population study, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Stopping smoking after a myocardial infarction is potentially the most effective of all preventive measures: a systematic review and meta-analysis of 20 cohort studies showed a mortality benefit of 0.64 (95% CI 0.58-0.71) compared with continued smokers.

    “Stopping smoking after a myocardial infarction is potentially the most effective of all preventive measures: a systematic review and meta-analysis of 20 cohort studies of smoking cessation after myocardial infarction showed a mortality benefit of 0.64 [95% confidence interval (CI) 0.58-0.71]compared with continued smokers.249”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [249] Critchley, 2004, Smoking cessation for the secondary prevention of coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All available forms of nicotine replacement therapy are effective for abstinence; systematic review OR 1.58 (95% CI 1.50-1.66) versus control.

    “All available forms of NRT are effective: in a systematic review, the OR for abstinence with NRT vs. control was 1.58 (95% CI 1.50-1.66).213”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [213] Stead, 2008, Nicotine replacement therapy for smoking cessation, Cochrane Database Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individual and group behavioural support both help smokers to stop.

    “Both individual and group behavioural interventions are effective in helping smokers quit.225,266 -268”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [225] Raupach, 2006, Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm, Eur Heart J source

      Not checked in the free run.

    • cites [266] Stead, 2005, Group behaviour therapy programmes for smoking cessation, Cochrane Database Syst Rev source

      Not checked in the free run.

    • cites [267] Lancaster, 2005, Individual behavioural counselling for smoking cessation, Cochrane Database Syst Rev source

      Not checked in the free run.

    • cites [268] Rice, 2004, Nursing interventions for smoking cessation, Cochrane Database Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Public health measures such as smoking bans, tobacco taxation, and media campaigns are efficient aids in preventing smoking uptake and supporting smoking cessation.

    “Public health measures such as smoking bans, tobacco taxation, and media campaigns are efficient aids in preventing smoking uptake and supporting smoking cessation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The risk is rapidly reduced after cessation, with significant morbidity reductions reported within the first 6 months.

    “The risk is rapidly reduced after cessation, with significant morbidity reductions reported within the first 6 months.250”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [250] Chow, 2010, Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cytisine seems to increase quitting chances, but the evidence is not conclusive.

    “Cytisine, a low cost partial nicotine receptor agonist available in some European countries, also seems to increase the chances of quitting, but the evidence at present is not conclusive.264”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [264] West, 2011, Placebo-controlled trial of cytisine for smoking cessation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low doses of EPA and DHA are associated with lower risk of fatal CHD but not non-fatal CHD.

    “In various studies, low doses of eicosapentaenoic acid and docosahexaenoic acid are associated with a lower risk of fatal CHD but not of non-fatal CHD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [271] He, 2004, Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Methodological issues may explain the null finding for saturated fat and CVD.

    “although there may be several methodological issues explaining this null finding.280”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [280] Stamler, 2010, Diet–heart: a problematic revisit, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    EPA and DHA do not affect serum cholesterol but reduce CHD mortality and, to a lesser extent, stroke mortality.

    “They do not have an impact on serum cholesterol levels, but have been shown to reduce CHD mortality and to a lesser extent stroke mortality.271,282”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [271] He, 2004, Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies, Circulation source

      Not checked in the free run.

    • cites [282] He, 2004, Fish consumption and incidence of stroke: a meta-analysis of cohort studies, Stroke source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The European Medicines Agency stated that varenicline's small excess cardiovascular risk is outweighed by its smoking-cessation benefit.

    “the European Medicines Agency has announced that the slightly increased risk of cardiovascular events associated with varenicline does not outweigh the benefits of the drug in helping people to stop smoking.263”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [263] Hawkes, 2011, Varenicline raises risk of heart problems, analysis indicates, BMJ

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The mortality benefit was consistent over gender, duration of follow-up, study site, and time period.

    “The mortality benefit was consistent over gender, duration of follow-up, study site, and time period.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [249] Critchley, 2004, Smoking cessation for the secondary prevention of coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Nortriptyline and clonidine aid smoking cessation but are second-line choices because of side effects.

    “The antidepressant nortriptyline and the antihypertensive drug clonidine aid smoking cessation, 258,265 but, owing to side effects, are second-line choices.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [258] Hughes, 2007, Antidepressants for smoking cessation, Cochrane Database Syst Rev source

      Not checked in the free run.

    • cites [265] Gourlay, 2004, Clonidine for smoking cessation, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Plaque formation is not thought to be fully reversible and thus smokers would never be expected to reach the risk level of never-smokers concerning CVD.

    “Plaque formation is not thought to be fully reversible and thus smokers would never be expected to reach the risk level of never-smokers concerning CVD.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The American Institute of Medicine recommends an intake of 3.4 g/MJ, equivalent to 30-45 g/day for adults.

    “The American Institute of Medicine recommends an intake of 3.4 g/MJ, equivalent to an intake of 30 -45 g/day for adults.296”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [296] Food and Nutrition Board, 2002

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Seven Countries Study showed a large difference in cardiovascular mortality rates between northern and southern Europe; even at similar cholesterol levels and after adjusting for BP and smoking, the difference in cardiovascular risk remained.

    “The Seven Countries Study showed a large difference in cardiovascular mortality rates between northern and southern Europe.Even at similar cholesterol levels, and after adjusting for BP and smoking, the difference in cardiovascular risk remained (Figure 8).304”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [304] Verschuren, 1995, Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk of CVD (including CHD and stroke) or CHD alone is significantly reduced in more physically active or fit persons, with relative risk reduction nearly twice as great for cardiorespiratory fitness than for physical activity increase at all percentiles >25th.

    “The risk of CVD (including CHD and stroke) or CHD alone is significantly reduced in more physically active or fit persons, with a relative risk reduction nearly twice as great for cardiorespiratory fitness than for physical activity increase at all percentiles .25th.308,328,329”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [308] Schnohr, 2007, Intensity versus duration of walking, impact on mortality: the Copenhagen City Heart Study, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

    • cites [328] Williams, 2001, Physical fitness and activity as separate heart disease risk factors: a meta-analysis, Med Sci Sports Exerc source

      Not checked in the free run.

    • cites [329] Tipton, 2006

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A simulation study estimated that reducing salt intake by 3 g/day in the USA would reduce CHD incidence by 5.9-9.6%, stroke incidence by 5.0-7.8%, and death from any cause by 2.6-4.1%.

    “A recent simulation study estimated that for the USA, a reduction in salt intake of 3 g/day would result in a reduction of 5.9 -9.6% in the incidence of CHD (low and high estimate based on different assumptions), a reduction of 5.0 -7.8% in the incidence of stroke, and a reduction of 2.6-4.1% in death from any cause.286”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [286] Bibbins-Domingo, 2010, Projected effect of dietary salt reductions on future cardiovascular disease, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A modest increase in fish consumption of 1-2 servings a week would reduce CHD mortality by 36% and all-cause mortality by 17%.

    “A modest increase in fish consumption of 1 -2 servings a week would reduce CHD mortality by 36% and all-cause mortality by 17%.298”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [298] Mozaffarian, 2006, Fish intake, contaminants, and human health: evaluating the risks and the benefits, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High fibre intake reduces post-prandial glucose responses after carbohydrate-rich meals and lowers total and LDL cholesterol levels.

    “Although the mechanism is not elucidated completely, it is known that a high fibre intake reduces post-prandial glucose responses after carbohydrate-rich meals, and lowers total and LDL cholesterol levels.295”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [295] Weickert, 2008, Metabolic effects of dietary fiber consumption and prevention of diabetes, J Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A Cochrane meta-analysis of eight RCTs found homocysteine-lowering interventions did not reduce risk of fatal/non-fatal MI (RR 1.03, 95% CI 0.94-1.13), stroke (RR 0.89, 95% CI 0.73-1.08), or death by any cause (RR 1.00, 95% CI 0.92-1.09).

    “The Cochrane Collaboration concluded in a recent meta-analysis of eight RCTs that homocysteine-lowering interventions did not reduce the risk of fatal/non-fatal myocardial infarction (RR 1.03, 95% CI 0.94-1.13),stroke (RR 0.89, 95% CI 0.73 -1.08), or death by any cause (RR 1.00, 95% CI 0.92-1.09).290”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [290] Marti-Carvajal, 2009, Homocysteine lowering interventions for preventing cardiovascular events, Cochrane Database Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    He et al. reported pooled RR of stroke 0.89 (95% CI 0.83-0.97) for eating 3-5 servings of fruits and vegetables daily compared with <3 servings, and 0.74 (95% CI 0.69-0.79) for >5 servings.

    “He et al. updated this estimate by adding two additional cohorts, and reported a pooled RR of stroke of 0.89 (95% CI 0.83 -0.97) for those eating 3-5 servings of fruits and vegetables daily compared with those eating ,3 servings, and a pooled RR of 0.74 (95% CI 0.69-0.79)for those eating .5 servings.274”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [274] He, 2006, Fruit and vegetable consumption and stroke: meta-analysis of cohort studies, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Greater adherence to the Mediterranean diet, by a 2-point higher score, is associated with a 10% reduction in cardiovascular incidence or mortality (pooled RR 0.90, 95% CI 0.87-0.93) and an 8% reduction in all-cause mortality (pooled RR 0.92, 95% CI 0.90-0.94).

    “The meta-analysis showed that greater adherence to the Mediterranean diet, by a 2-point higher score, was associated with a 10% reduction in cardiovascular incidence or mortality (pooled RR 0.90, 95% CI 0.87-0.93)and also with an 8% reduction in all-cause mortality (pooled RR 0.92, 95% CI 0.90-0.94).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [276] Sofi, 2010, Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Regular consumption of sugar-sweetened beverages (two servings per day compared with one serving per month) is associated with a 35% higher risk of CHD in women, even after accounting for other unhealthy lifestyle and dietary factors; artificially sweetened beverages were not associated with CHD.

    “Similarly, regular consumption of sugar-sweetened beverages (i.e. two servings per day compared with one serving per month) was associated with a 35% higher risk of CHD in women, even after other unhealthy lifestyle and dietary factors were accounted for, whereas artificially sweetened beverages were not associated with CHD.301”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [301] Fung, 2009, Sweetened beverage consumption and risk of coronary heart disease in women, Am J Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The volume of moderate-intensity physical activity or aerobic exercise training that reduces all-cause and cardiovascular mortality ranges from 2.5 to 5 h/week; longer total weekly duration is associated with greater benefits.

    “The volume of moderate-intensity physical activity or aerobic exercise training able to provide a reduction in all-cause and cardiovascular mortality ranges from 2.5 to 5 h/week; 306 -308,311,312 the longer the total duration of physical activity/aerobic exercise training performed over the week the greater the observed benefits.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [306] Nocon, 2008, Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

    • cites [307] Lollgen, 2009, Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories, Int J Sports Med source

      Not checked in the free run.

    • cites [308] Schnohr, 2007, Intensity versus duration of walking, impact on mortality: the Copenhagen City Heart Study, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

    • cites [311] US Department of Health and Human Services, 2008, Physical Activity Guidelines Advisory Committee Report

      Not checked in the free run.

    • cites [312] Richardson, 2004, Physical activity and mortality across cardiovascular disease risk groups, Med Sci Sports Exerc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with prior acute myocardial infarction, CABG, PTCA, or stable angina, aerobic exercise training has no effect on non-fatal myocardial infarction, and data are insufficient on revascularization rates.

    “Insufficient data were available as to the effects of aerobic exercise training on revascularization rates; moreover, aerobic exercise training did not show any effect on the occurrence of non-fatal myocardial infarction.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [333] Heran, 2011, Exercise-based cardiac rehabilitation for coronary heart disease, Cochrane Database Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In hostile CHD patients, group-based hostility-control intervention may decrease hostility, depression, resting heart rate, and cardiovascular reactivity to mental stress, and increase social support and life satisfaction.

    “In hostile CHD patients, a group-based hostility-control intervention may lead not only to decreases in behaviourally assessed hostility levels, but also to decreased levels of depression, resting heart rate, and cardiovascular reactivity to mental stress, as well as to increased social support and satisfaction with life.359,360”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [359] Gidron, 1999, The short-term effects of a hostility-reduction intervention on male coronary heart disease patients, Health Psychol source

      Not checked in the free run.

    • cites [360] Bishop, 2005, Effects of a psychosocial skills training workshop on psychophysiological and psychosocial risk in patients undergoing coronary artery bypass grafting, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    The total weekly volume of physical activity/aerobic exercise training can be obtained by summing multiple daily bouts each lasting ≥10 min, and should be distributed over most days of the week.

    “Moreover, the available evidence suggests that the total weekly volume of physical activity/aerobic exercise training can be obtained by summing multiple daily bouts of exercise, each lasting ≥10 min, and that physical activity/aerobic exercise training should be distributed over most days of the week.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Major cardiovascular events during supervised aerobic exercise training in cardiac rehabilitation are rare: 1 in 50,000 to 1 in 120,000 patient-hours, with fatality 1 in 340,000 to 1 in 750,000 patient-hours.

    “The occurrence of major cardiovascular events during supervised aerobic exercise training in cardiac rehabilitation programmes is rare: from 1 in 50 000 to 1 in 120 000 patient-hours of exercise, with fatality incidence ranging between 1 in 340 000 and 1 in 750 000 patienthours of exercise.340,341”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [340] Franklin, 1998, Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: a 16-year follow-up, Chest source

      Not checked in the free run.

    • cites [341] Scheinowitz, 2005, Safety of cardiac rehabilitation in a medically supervised, community-based program, Cardiology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with chronic heart failure due to left ventricular systolic dysfunction, moderate to vigorous aerobic exercise training improves survival and significantly extends time to readmission.

    “Overall, moderate to vigorous intensity aerobic exercise training resulted in improved survival in patients with chronic heart failure due to left ventricular systolic dysfunction, and time to readmission to hospital was also significantly extended.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [310] Piepoli, 2004, Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH), BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A secondary analysis of an RCT found beneficial cardiovascular effects only in white men and in patients who responded to antidepressant treatment.

    “A secondary analysis of another RCT found beneficial cardiovascular effects in white men only, 344 and in patients who responded to antidepressant treatment.346”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [344] Schneiderman, 2004, Psychosocial treatment within sex by ethnicity subgroups in the Enhancing Recovery in Coronary Heart Disease clinical trial, Psychosom Med source

      Not checked in the free run.

    • cites [346] Carney, 2004, Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, Psychosom Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Prognosis improvement from aerobic exercise training in chronic heart failure is greater in patients with ischaemic aetiology, lower left ventricular ejection fraction and peak VO2, and higher NYHA class.

    “Prognosis improvement was higher in patients with ischaemic aetiology, lower left ventricular ejection fraction and peak VO 2 , and higher New York Heart Association class.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [310] Piepoli, 2004, Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH), BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy or SSRIs, but evidence for a beneficial effect on cardiac endpoints is inconclusive.

    “Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy 84,85,351 -353 or selective serotonin re-uptake inhibitors, 354 -356 although evidence for a beneficial effect on cardiac endpoints is inconclusive.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [84] Rollman, 2009, Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial, JAMA source

      Not checked in the free run.

    • cites [85] Davidson, 2010, Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial, Arch Intern Med source

      Not checked in the free run.

    • cites [351] Berkman, 2003, Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial, JAMA source

      Not checked in the free run.

    • cites [352] Lesperance, 2007, Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial, JAMA source

      Not checked in the free run.

    • cites [353] Freedland, 2009, Treatment of depression after coronary artery bypass surgery: a randomized controlled trial, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [354] Glassman, 2002, Sertraline treatment of major depression in patients with acute MI or unstable angina, JAMA source

      Not checked in the free run.

    • cites [355] van Melle, 2007, Effects of antidepressant treatment following myocardial infarction, Br J Psychiatry source

      Not checked in the free run.

    • cites [356] Dowlati, 2010, Efficacy and tolerability of antidepressants for treatment of depression in coronary artery disease: a meta-analysis, Can J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Risk stratification algorithms identify patients at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring; safety of medically supervised exercise programmes following such indications is well established.

    “Available risk stratification algorithms help to identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring, 338,339 and the safety of medically supervised exercise programmes that follow such indications for exercise-related risk stratification is well established.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [338] American Association of Cardiovascular & Pulmonary Rehabilitation, 2004

      Not checked in the free run.

    • cites [339] American College of Sports Medicine, 2009

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most studies showed no significant beneficial effect of treating depression on cardiac endpoints, but a recent RCT revealed fewer depressive symptoms and fewer major adverse cardiac events.

    “Whereas most studies could show no significant beneficial effect, 84,351 -356 a recent RCT revealed fewer depressive symptoms as well as fewer major adverse cardiac events.85”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [84] Rollman, 2009, Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial, JAMA source

      Not checked in the free run.

    • cites [351] Berkman, 2003, Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial, JAMA source

      Not checked in the free run.

    • cites [352] Lesperance, 2007, Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial, JAMA source

      Not checked in the free run.

    • cites [353] Freedland, 2009, Treatment of depression after coronary artery bypass surgery: a randomized controlled trial, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [354] Glassman, 2002, Sertraline treatment of major depression in patients with acute MI or unstable angina, JAMA source

      Not checked in the free run.

    • cites [355] van Melle, 2007, Effects of antidepressant treatment following myocardial infarction, Br J Psychiatry source

      Not checked in the free run.

    • cites [356] Dowlati, 2010, Efficacy and tolerability of antidepressants for treatment of depression in coronary artery disease: a meta-analysis, Can J Psychiatry source

      Not checked in the free run.

    • cites [85] Davidson, 2010, Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In low-risk patients, aerobic exercise training is at least as effective as PCI in improving clinical status and myocardial perfusion and is associated with fewer cardiovascular events.

    “aerobic exercise training in low-risk patients has been shown to be at least as effective in improving clinical status and myocardial perfusion, and associated with fewer cardiovascular events as compared with an invasive strategy such as a PCI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [336] Hambrecht, 2004, Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Stress-management programmes improve subjective well-being, risk factor levels, and CVD outcomes.

    “Stress-management programmes have repeatedly been shown to improve not only subjective well-being but also risk factor levels and CVD outcomes.199,200,358”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [199] Linden, 2007, Psychological treatment of cardiac patients: a meta-analysis, Eur Heart J source

      Not checked in the free run.

    • cites [200] Rees, 2004, Psychological interventions for coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [358] Gulliksson, 2011, Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM), Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One RCT of a nurse-led home-based intervention in post-CABG patients showed beneficial effects on anxiety, but sample size and follow-up were too limited to demonstrate impact on cardiac events.

    “One RCT involving a nurse-led, home-based intervention in post-CABG patients revealed beneficial effects on anxiety, but the sample was too small and the follow-up period too short to demonstrate an impact on cardiac events.357”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [357] Lie, 2007, Effects of a home-based intervention program on anxiety and depression 6 months after coronary artery bypass grafting: a randomized controlled trial, J Psychosom Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Reduction of work stress in managers and supervisors may have beneficial health effects on them and improve perceived social support in subordinates.

    “Hence, reduction of work stress in managers and supervisors may have beneficial health effects on the target individuals and may also improve perceived social support in their subordinates.362”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [362] Theorell, 2001, Employee effects of an educational program for managers at an insurance company, Psychosom Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Europe, general obesity and abdominal adiposity are both associated with increased risk of death.

    “In Europe, a recent study of nearly 360 000 participants from nine European countries showed that general obesity and abdominal adiposity are both associated with increased risk of death.372”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [372] Pischon, 2008, General and abdominal adiposity and risk of death in Europe, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Obesity is becoming a worldwide epidemic in both children and adults.

    “Obesity is becoming a worldwide epidemic in both children and adults.370”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [370] Poirier, 2006, Obesity, cardiovascular disease: pathophysiology, evaluation, effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multimodal behavioural interventions can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.

    “This approach can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [85] Davidson, 2010, Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial, Arch Intern Med source

      Not checked in the free run.

    • cites [86] Katon, 2010, Collaborative care for patients with depression and chronic illnesses, N Engl J Med source

      Not checked in the free run.

    • cites [199] Linden, 2007, Psychological treatment of cardiac patients: a meta-analysis, Eur Heart J source

      Not checked in the free run.

    • cites [200] Rees, 2004, Psychological interventions for coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [343] Whalley, 2011, Psychological interventions for coronary heart disease, Cochrane Database Syst Rev source

      Not checked in the free run.

    • cites [344] Schneiderman, 2004, Psychosocial treatment within sex by ethnicity subgroups in the Enhancing Recovery in Coronary Heart Disease clinical trial, Psychosom Med source

      Not checked in the free run.

    • cites [345] Taylor, 2005, Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [346] Carney, 2004, Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, Psychosom Med source

      Not checked in the free run.

    • cites [347] Sauer, 2003, Effect of antidepressants and their relative affinity for the serotonin transporter on the risk of myocardial infarction, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Evidence is accumulating that psychological interventions counteract psychosocial stress, promote healthy behaviours, and contribute to CVD prevention.

    “Evidence is accumulating to suggest that psychological interventions counteract psychosocial stress, promote healthy behaviours, and contribute to the prevention of CVD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Visceral adipose tissue process impacts CVD risk factors and risk; mechanical effects of overweight impact non-cardiovascular morbidity and mortality.

    “This process impacts on CVD risk factors and hence on risk, and the mechanical effects of overweight impact on non-cardiovascular causes of morbidity and mortality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Due to poorer accuracy and reliability of waist and hip measurements, they cannot be established as alternatives to BMI in routine practice; BMI was not a stronger predictor than other measures, while central obesity measures had somewhat stronger associations with all-cause mortality and type 2 diabetes.

    “On the basis of evidence regarding the poorer accuracy and reliability of measuring waist circumference and hip circumference, 381 -383 it is not possible to establish these measures of visceral adiposity as alternatives to BMI in routine practice; it is also notable that BMI was not a stronger predictor of any outcomes than were the other measures, whereas measures of central obesity had somewhat”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [381] Sebo, 2008, Reliability of doctors' anthropometric measurements to detect obesity, Prev Med source

      Not checked in the free run.

    • cites [382] Nadas, 2008, Intraobserver and interobserver variability of measuring waist circumference, Med Sci Monit

      Not checked in the free run.

    • cites [383] Nordhamn, 2000, Reliability of anthropometric measurements in overweight and lean subjects: consequences for correlations between anthropometric and other variables, Int J Obes Relat Metab Disord source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis of 32 studies found no overall difference between BMI, waist circumference, and waist:hip ratio in association with incident diabetes, and no important sex differences.

    “A recent meta-analysis of 32 studies found no overall difference between BMI, waist circumference, and waist:hip ratio in their association with incident diabetes, 378 and showed no important differences between the sexes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [378] Vazquez, 2007, Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis, Epidemiol Rev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    At population level, obesity is associated with increased CVD incidence and mortality; among those with established coronary artery disease, evidence is contradictory.

    “If, at the population level, obesity is associated with an increased risk of CVD incidence and mortality, among those with established coronary artery disease, the evidence is contradictory.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [366] Romero-Corral, 2006, Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies, Lancet source

      Not checked in the free run.

    • cites [367] Oreopoulos, 2008, Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis, Obesity (Silver Spring) source

      Not checked in the free run.

    • cites [368] Hastie, 2010, Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention, Eur Heart J source

      Not checked in the free run.

    • cites [369] Lavie, 2009, Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Waist circumference thresholds are based on Caucasians; different cut-off points are required in different races and ethnicities.

    “These thresholds have been calculated based on Caucasians and it is apparent that different cut-off points for anthropometric measurements are required in different races and ethnicities.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    In EPIC, BMI, waist circumference, and waist:hip ratio were all independently associated with all-cause mortality; authors recommended waist circumference or waist:hip ratio in addition to BMI; no direct comparisons of magnitudes were made.

    “In the multicentre European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study, BMI, waist circumference, and waist:hip ratio were all independently associated with allcause mortality; the authors recommended the use of waist circumference or waist:hip ratio in addition to BMI for assessing risk of death; however, no direct comparisons of the magnitudes of associations between”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [372] Pischon, 2008, General and abdominal adiposity and risk of death in Europe, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    ECG LVH can document LVH regression, possibly associated with reduced incidence of new-onset AF.

    “ECG LVH can be used as a tool documenting LVH regression, possibly associated with a reduced incidence of new-onset AF. 419”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [419] Okin, 2004, Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Carotid-femoral pulse wave velocity provides a comprehensive non-invasive assessment of arterial stiffness and has independent predictive value for all-cause and cardiovascular morbidity, coronary events, and strokes in patients with uncomplicated essential hypertension and in the general population.

    “Measurement of carotid -femoral pulse wave velocity provides a comprehensive non-invasive assessment of arterial stiffness 423 and has an independent predictive value for all-cause and cardiovascular morbidity, coronary events, and strokes in patients with uncomplicated essential hypertension as well as in the general population.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [423] Willum-Hansen, 2006, Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Long-acting drugs minimize blood pressure variability, which may offer protection against progression of organ damage and risk of cardiovascular events.

    “Long-acting drugs also minimize BP variability, which may offer protection against progression of organ damage and risk of cardiovascular events.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Carotid alterations are common in untreated hypertensive individuals without target organ damage on routine examination; thus, carotid ultrasound may often detect vascular damage and make risk stratification more precise.

    “These alterations are common in untreated hypertensive individuals without target organ damage on routine examination; thus, carotid ultrasound may often detect vascular damage and make risk stratification more precise.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Ultrasound scans limited to common carotid arteries are likely to detect vascular hypertrophy only, whereas assessment of atherosclerosis also requires scanning bifurcations and/or internal carotids where plaques are more frequent.

  • May combine two claims.

    Premisecitation

    A low ABI indicates advanced atherosclerosis, whereas carotid IMT measurements detect earlier changes.

    “A low ABI indicates advanced atherosclerosis, 422 whereas carotid IMT measurements are able to detect earlier changes.421”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [422] Feringa, 2006, The long-term prognostic value of the resting and postexercise ankle–brachial index, Arch Intern Med source

      Not checked in the free run.

    • cites [421] Touboul, 2004, Mannheim intima-media thickness consensus, Cerebrovasc Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Observational evidence shows BP levels correlate negatively with cognitive function and hypertension is associated with increased incidence of dementia.

    “Observational evidence is also available that BP levels correlate negatively with cognitive function and that hypertension is associated with an increased incidence of dementia.411”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [411] Skoog, 1996, 15-year longitudinal study of blood pressure and dementia, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    It remains unclear whether drug-induced diabetes carries the same negative prognosis as naturally occurring diabetes.

    “Furthermore, it is still unclear whether drug-induced diabetes carries the same negative prognosis as naturally occurring diabetes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In hypertensive patients with and without diabetes, microalbuminuria even below current threshold predicts cardiovascular events, and a continuous relationship exists between cardiovascular and non-cardiovascular mortality and urinary protein/creatinine ratios ≥3.9 mg/g in men and ≥7.5 mg/g in women.

    “In hypertensive patients with and without diabetes, microalbuminuria, even below the currently used threshold values, predicts cardiovascular events, 424 and a continuous relationship between cardiovascular as well as non-cardiovascular mortality and urinary protein/creatinine ratios ≥3.9 mg/g in men and ≥7.5 mg/ g in women has been reported in several studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [424] Sarnak, 2003, Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Subclinical organ damage predicts cardiovascular death independently of SCORE, and the combination may improve risk prediction especially in subjects at low or moderate risk (SCORE 1-4%).

    “In conclusion, there is evidence that subclinical organ damage predicts cardiovascular death independently of SCORE, and the combination may improve risk prediction, especially in subjects at low or moderate risk (SCORE 1-4%).400”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [400] Sehestedt, 2010, Risk prediction is improved by adding markers of subclinical organ damage to SCORE, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some studies show wide pulse pressure is a better predictor of adverse cardiovascular outcomes than SBP or DBP individually, and identifies patients with systolic hypertension at particularly high risk.

    “A wide pulse pressure (SBP minus DBP) has been shown in some studies to be a better predictor of adverse cardiovascular outcomes than either SBP or DBP individually, 413 and to identify patients with systolic hypertension who are at particularly high risk.414”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [413] Franklin, 2001, Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study, Circulation source

      Not checked in the free run.

    • cites [414] Benetos, 2000, A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Elevated BP is a major risk factor for CHD, heart failure, cerebrovascular disease, PAD, renal failure, and atrial fibrillation.

    “Elevated BP is a major risk factor for CHD, heart failure, cerebrovascular disease, PAD, renal failure, and atrial fibrillation.”
    • Also stated in: § 4.7.1 Introduction · plain
      “In a number of epidemiological studies, elevated BP has been identified as a risk factor for CHD, heart failure, cerebrovascular disease, PAD renal failure, and, more recently, atrial fibrillation (AF).409,410”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [409] MacMahon, 1990, Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias, Lancet source

      Not checked in the free run.

    • cites [410] Wattigney, 2003, Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Cardiac abnormalities detected by echocardiography more precisely quantify left ventricular mass and geometric LVH patterns, and have additional predictive power.

    “Cardiac abnormalities detected by echocardiography more precisely quantify left ventricular mass and geometric LVH patterns, and have an additional predictive power.420”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [420] Taylor, 2007, Left ventricular architecture and survival in African-Americans free of coronary heart disease (from the Atherosclerosis Risk in Communities [ARIC] study), Am J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    It cannot be ruled out that being underweight is associated with increased cardiovascular morbidity and mortality.

    “It cannot be ruled out that being underweight is associated with increased cardiovascular morbidity and mortality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The reason for the poorer outcome in the intensive group in ACCORD is not clear but may be associated with hypoglycaemia.

    “The reason for the poorer outcome in the intensive group is not clear, but may be associated with hypoglycaemia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Fixed-dose combinations simplify treatment and may improve patient compliance.

    “Fixed-dose combinations simplify treatment and may thus improve patient compliance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Cardiovascular disease is the leading cause of morbidity and mortality in people with diabetes mellitus.

    “Cardiovascular disease is the leading cause of morbidity and mortality in people with diabetes mellitus.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Hypertriglyceridaemia is a significant independent risk factor for cardiovascular disease, though its association is weaker than that of hypercholesterolaemia.

    “Hypertriglyceridaemia is a significant independent CVD risk factor, but it seems that the association is not as strong as for hypercholesterolaemia.55”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Sarwar, 2007, Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Familial hypercholesterolaemia is a dominantly inherited condition affecting 1 in 500 people of European descent (heterozygous), most commonly caused by a mutation of the LDL receptor, and characterized by very high LDL cholesterol levels (usually 5-10 mmol/L).

    “Familial hypercholesterolaemia is a dominantly inherited condition affecting 1 in 500 people of European descent (heterozygous) most commonly caused by a mutation of the LDL receptor, and is characterized by very high levels of LDL cholesterol (usually 5-10 mmol/L or 200-400 mg/dL).42”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Reiner, 2011, ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Non-fasting triglycerides may predict coronary heart disease risk even better than fasting triglycerides, because individuals are in the postprandial state most of the time.

    “There is evidence that non-fasting triglycerides may predict CHD risk even better, as individuals are in the postprandial state most of the time.477”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [477] Nordestgaard, 2007, Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with transient ischaemic attack or ischaemic stroke, dipyridamole plus aspirin versus clopidogrel alone had similar rates of recurrent stroke, including haemorrhagic stroke (916 vs 898; HR 1.01, 95% CI 0.92-1.11), with a higher frequency of major haemorrhagic events with dipyridamole plus aspirin (4.1% vs 3.6%); stroke, myocardial infarction, and vascular death occurred in 13.1% in

    “In patients with transient ischaemic attack or ischaemic stroke, a direct comparison of dipyridamole plus aspirin vs. clopidogrel alone 508 showed that the two regimens had similar rates of recurrent stroke, including haemorrhagic stroke (916 vs. 898; HR 1.01, 95% CI 0.92-1.11).There was a higher frequency of major haemorrhagic events with dipyridamole plus aspirin (4.1% vs. 3.6%).Stroke,”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [508] Sacco, 2008, Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    With ticagrelor given for 12 months, the composite endpoint of death from vascular causes, myocardial infarction, or stroke occurred in 9.8% versus 11.7% with clopidogrel (HR 0.84, 95% CI 0.77-0.92; P<0.001), with no significant difference in major bleeding.

    “With ticagrelor given for 12 months the composite endpoint of death from vascular causes, myocardial infarction, or stroke occurred in 9.8% as compared with 11.7% of those receiving clopidogrel (HR 0.84, 95% CI 0.77-0.92;P , 0.001).No significant difference in rate of major bleeding was found.501 -503”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [501] Wiviott, 2007, Prasugrel versus clopidogrel in patients with acute coronary syndromes, N Engl J Med source

      Not checked in the free run.

    • cites [502] Gurbel, 2009, Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study, Circulation source

      Not checked in the free run.

    • cites [503] Wallentin, 2009, Ticagrelor versus clopidogrel in patients with acute coronary syndromes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Statins, by decreasing LDL cholesterol, reduce cardiovascular morbidity and mortality and the need for coronary artery interventions.

    “Statins, by decreasing LDL cholesterol, reduce cardiovascular morbidity and mortality as well as the need for coronary artery interventions.166,436”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [166] Colhoun, 2004, Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial, Lancet source

      Not checked in the free run.

    • cites [436] Collins, 2003, MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High cholesterol levels are a risk factor for ischaemic but not haemorrhagic stroke.

    “In contrast to earlier observations, recent studies have now shown that high cholesterol levels are a risk factor for ischaemic but not haemorrhagic stroke.489”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [489] Hebert, 1997, Cholesterol lowering with statin drugs, risk of stroke, and total mortality. An overview of randomized trials, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with prior non-cardioembolic ischaemic stroke, oral vitamin K antagonists are not superior to aspirin but are associated with a higher bleeding risk.

    “In such patients oral vitamin K antagonists are not superior to aspirin but are associated with a higher bleeding risk.512,513”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [512] Mohr, 2001, A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke, N Engl J Med source

      Not checked in the free run.

    • cites [513] Liu, 2000, Anticoagulants for preventing recurrence following ischaemic stroke or transient ischaemic attack, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Solely reducing dosage demands resulted in strong effects (effect size 0.89-1.20), but other interventions such as repetitive monitoring and feedback (effect size 0.27-1.2), multisession information (effect size 0.35-1.13), and combined behavioural interventions (effect size 0.43-1.20) have shown effects ranging from low to strong.

    “Solely reducing dosage demands resulted in strong effects (effect size 0.89-1.20),but other interventions such as repetitive monitoring and feedback (effect size 0.27 -1.2), multisession information (effect size 0.35 -1.13), and combined behavioural interventions (effect size 0.43-1.20)have shown effects ranging from low to strong.520”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [520] Kripalani, 2007, Interventions to enhance medication adherence in chronic medical conditions: a systematic review, Arch Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The World Health Organization has categorized potential reasons for medication non-adherence into five broad groupings: health system-related, condition, patient, therapy, and socio-economic factors.

    “As outlined in Table 18, the WHO has categorized potential reasons for medication non-adherence into five broad groupings that include health system-related, condition, patient, therapy, and socio-economic factors.518”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [518] Ho, 2009, Medication adherence: its importance in cardiovascular outcomes, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent systematic review has shown that several types of interventions are effective in improving adherence in chronic medical conditions; however, effect sizes on adherence varied and so did medical outcome.

    “A recent systematic review has shown that several types of interventions are effective in improving adherence in chronic medical conditions; however, effect sizes on adherence varied and so did medical outcome.520”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [520] Kripalani, 2007, Interventions to enhance medication adherence in chronic medical conditions: a systematic review, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    With prasugrel, the primary efficacy endpoint occurred in 9.9% versus 12.1% with clopidogrel (HR 0.81, 95% CI 0.73-0.90; P<0.001), and the risk of major bleeding was increased.

    “With prasugrel, the primary efficacy endpoint occurred in 9.9% of patients as compared with 12.1% receiving clopidogrel (HR 0.81, 95% CI 0.73-0.90;P , 0.001).The risk of major bleeding was increased with prasugrel.501”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [501] Wiviott, 2007, Prasugrel versus clopidogrel in patients with acute coronary syndromes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 16 trials comprising 17,000 individuals, allocation to aspirin was associated with serious vascular events in 6.7% per year versus 8.2% of controls; total stroke 2.08% versus 2.59% (P=0.002); coronary events 4.3% versus 5.3% (P=0.0001); aspirin was associated with a 10% reduction in total mortality (RR 0.90, 95% CI 0.82-0.99) and a significant excess of major bleeds, but the

    “In a meta-analysis of 16 trials comprising 17 000 individuals, the Antithrombotic Trialists' Collaboration, 2009 507 found that allocation to aspirin was associated with serious vascular events in 6.7% of patients per year vs. 8.2% of controls.The risk of total stroke was 2.08% per year vs. 2.59% (P ¼ 0.002) and coronary events 4.3% per year vs. 5.3% (P ¼ 0.0001).Aspirin was associated with a 10%”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [507] Baigent, 2009, Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    As adherence with placebo also improves survival, adherence to medication may reflect generally better health behaviour.

    “In addition, as adherence with placebo also improves survival, 524 physicians should be aware that adherence to medication may reflect generally better health behaviour.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [524] Simpson, 2006, A meta-analysis of the association between adherence to drug therapy and mortality, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Statin therapy has a beneficial effect on cardiovascular disease outcomes in chronic kidney disease stages 2 and 3 and slows the rate of kidney function loss.

    “Statin therapy has a beneficial effect on CVD outcomes in CKD stages 2 and 3 and slows the rate of kidney function loss.493”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [493] Fellstrom, 2009, Rosuvastatin and cardiovascular events in patients undergoing hemodialysis, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other CVD risk factors such as smoking, high blood pressure, and obesity are undermanaged and show little improvement over time.

    “There is also the issue of undermanagement and little improvement over time in other CVD risk factors such as smoking, high BP, and obesity.540”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [540] Wood, 2007, Clinical reality of coronary prevention in Europe: a comparison of EUROPASPIRE I, II, and III surveys. Paper presented at, The 29th Annual Congress of the European Society of Cardiology

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A link exists between accuracy in recordings and both quality of care and adherence to guidelines.

    “A link exists between accuracy in recordings and both quality of care and adherence to guidelines.437”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [437] Heidenreich, 2011, Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Physicians are concerned about overestimating risk in national populations, which may lead to overuse of medical therapy.

    “Physicians are also concerned about overestimating risk in national populations, which may lead to overuse of medical therapy.545,547”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [545] van Steenkiste, 2004, Barriers to implementing cardiovascular risk tables in routine general practice, Scand J Prim Health Care source

      Not checked in the free run.

    • cites [547] Marshall, 2006, Estimating the value of information in strategies for identifying patients at high risk of cardiovascular disease, Inform Prim Care

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The affected individuals would include men and elderly people, who have a higher tendency to require lipid-lowering medications.

    “Affected individuals would include men and elderly individuals who would have a higher tendency to require lipid-lowering medications.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Barriers to implementing risk-adjusted prevention are multiple: risk scoring is considered time consuming, oversimplifies a complex situation, and may lead to overmedication.

    “Barriers to implementation of risk-adjusted prevention are multiple: risk scoring is considered to be time consuming, simplifying a complex situation, and may result in overmedication.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Other studies have demonstrated the effectiveness of nurse-led prevention clinics in primary care compared with usual care, with greater success in secondary as opposed to primary prevention.

    “Other studies have demonstrated the effectiveness of nurse-led prevention clinics in primary care compared with usual care, with greater success in secondary as opposed to primary prevention.532 -534”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [532] Voogdt-Pruis, 2010, Effectiveness of nurse-delivered cardiovascular risk management in primary care: a randomised trial, Br J Gen Pract source

      Not checked in the free run.

    • cites [533] Campbell, 1998, Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care, Heart source

      Not checked in the free run.

    • cites [534] Koelewijn-van Loon, 2010, Improving lifestyle and risk perception through patient involvement in nurse-led cardiovascular risk management: a cluster-randomized controlled trial in primary care, Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although self-testing showed no difference in hard endpoints, it gives greater independence and results in better quality of life.

    “Although there was no difference in hard endpoints, self-testing gives greater independence and results in a better quality of life.553”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [553] Matchar, 2010, Effect of home testing of international normalized ratio on clinical events, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Intuitive assessment based on personal experience appears to underestimate real CVD risk; physicians estimated CVD risk as less severe than the recommendations in WHO-International Society of Hypertension guidelines.

    “Although preferred by many physicians, intuitive assessment based on personal experience appears to underestimate the real risk of CVD: physicians (110 general practitioners and 29 internists) estimated CVD risk as being less severe than detailed in recommendations provided in the WHO-International Society of Hypertension guidelines.542,543”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [542] Persson, 2004, Doctors' estimation of cardiovascular risk and willingness to give drug treatment in hypertension: fair risk assessment but defensive treatment policy, J Hypertens source

      Not checked in the free run.

    • cites [543] 1999 World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee, 1999, J Hypertens

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Nurse case management models tested in several randomized trials of secondary prevention have shown significant improvements in risk factors, exercise tolerance, glucose control, and appropriate medication use, along with decreases in cardiac events and mortality, regression of coronary atherosclerosis, and improved patient perception of health compared with usual care.

    “Nurse case management models tested in several randomized trials of secondary prevention have shown significant improvements in risk factors, exercise tolerance, glucose control, and appropriate medication use, along with decreases in cardiac events and mortality, regression of coronary atherosclerosis, and improved patient perception of health compared with usual care.530,531”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [530] Berra, 2006, Cardiovascular disease prevention and disease management: a critical role for nursing, J Cardiopulm Rehabil source

      Not checked in the free run.

    • cites [531] Berra, 2011, Global cardiovascular disease prevention: a call to action for nursing: the global burden of cardiovascular disease, J Cardiovasc Nurs source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    57% of physicians believed that numerical information from prediction rules is frequently unhelpful for clinical decision-making.

    “More than half of the physicians (57%) believed that the numerical information resulting from prediction rules is frequently unhelpful for clinical decision-making.544”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [544] Eichler, 2007, Barriers to apply cardiovascular prediction rules in primary care: a postal survey, BMC Fam Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a survey of general practitioners and internists in two Swiss regions, 74% rarely or never used CVD prediction rules, citing fears of oversimplification (58%) or overuse of medical therapy (54%).

    “A survey among general practitioners and internists working in clinical practice in two Swiss regions revealed that 74% rarely or never used CVD prediction rules, 544 due to fears of oversimplification of risk assessment (58%) or overuse of medical therapy (54%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [544] Eichler, 2007, Barriers to apply cardiovascular prediction rules in primary care: a postal survey, BMC Fam Pract source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Most current CVD prevention risk calculators use short-term risk over 5 or 10 years, which makes them more likely to classify older people as high risk and younger people as low risk.

    “Most of the current CVD prevention risk calculators focus on shortterm (5 or 10 year) risk, and therefore inevitably are more likely to classify the elderly as at high risk and the young as at low risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The EUROACTION trial showed that a nurse-co-ordinated multidisciplinary prevention programme in hospitals and primary care practices led to healthier lifestyle changes in diet and physical activity, improvements in lifestyle, and more effective control of risk factors such as blood pressure in both patients and their partners in the intervention arm compared with usual care.

    “A nurse-co-ordinated multidisciplinary prevention programme in both hospitals and primary care practices was evaluated in the EUROACTION trial studying patients with CHD and those at high risk of CVD in eight countries.35 The approach was family centred and led to healthier lifestyle changes in terms of diet and physical activity, improvements in lifestyle (diet and physical activity), and more”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Wood, 2008, Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Incentives have been shown to be effective in the UK, where the Quality and Outcomes Framework links primary care income with achievement of specific evidence-based targets.

    “Incentives have been shown to be effective in the UK, where the Quality and Outcomes Framework (QOF) scheme links primary care income with achievement of specific evidencebased targets in healthcare delivery.549”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [549] Hedback, 1987, 5-year results of a comprehensive rehabilitation programme after myocardial infarction, Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    A thorough cardiologist examination will often profoundly change the risk score in many patients perceived to be at low risk.

    “This will in many patients with perceived low risk often change the risk score profoundly.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Nurse case management and nurse-coordinated multidisciplinary prevention programmes are more effective than usual care at reducing cardiovascular risk and can be adapted to various healthcare settings.

    “The evidence shows that nurse case management and nurse-co-ordinated multidisciplinary prevention programmes are more effective than usual care in reducing cardiovascular risk, and can be adapted to a variety of healthcare settings.”
    • Also stated in: § 5.1.2 Sustained contact is necessary for lifestyle change · plain
      “Nurse-led clinics or nurse-co-ordinated multidisciplinary prevention programmes are more effective than usual care in reducing cardiovascular risk, in a variety of healthcare settings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [531] Berra, 2011, Global cardiovascular disease prevention: a call to action for nursing: the global burden of cardiovascular disease, J Cardiovasc Nurs source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In an ESC survey across six European countries, 85% of cardiologists and physicians knew that CVD risk assessment should combine all CVD risk factors, but 62% used subjective methods instead of risk calculators.

    “An ESC survey conducted in six European countries indicates why physicians rely on their own expertise for the prevention and treatment of CHD: although most cardiologists and physicians (85%) knew they should base CVD risk assessment on the combination of all CVD risk factors, 62% of physicians used subjective methods to gauge risk rather than using risk calculators.541”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [541] Graham, 2006, Factors impeding the implementation of cardiovascular prevention guidelines: findings from a survey conducted by the European Society of Cardiology, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The most common barriers to guideline implementation were government or local health policy (40%), patient compliance (36%), and lack of time (23%).

    “The most common barriers to guideline implementation were government or local health policy (40%), patient compliance (36%), and lack of time (23%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [541] Graham, 2006, Factors impeding the implementation of cardiovascular prevention guidelines: findings from a survey conducted by the European Society of Cardiology, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Whether rehabilitation is ambulatory or residential is probably of lesser importance; duration, educational level, and patient motivation are also important for long-term outcome.

    “Whether the rehabilitation course is applied in an ambulatory setting or as a residential course is probably of lesser importance; the duration of the programme, the educational level, and the motivation of the patient are also important for long-term outcome.205”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [205] Piepoli, 2010, Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multivariable analysis adjusting for 14 clinical variables confirmed that compliance with all performance measures was statistically significantly higher for PCI patients than for CABG patients and was lowest for non-intervention patients.

    “Multivariable analysis adjusting for 14 clinical variables confirmed that compliance with all performance measures was statistically significantly higher for PCI patients than for CABG patients and was lowest for non-intervention patients.556”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [556] Hiratzka, 2007, Atherosclerosis secondary prevention performance measures after coronary bypass graft surgery compared with percutaneous catheter intervention and nonintervention patients in the Get With the Guidelines database, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Defect-free compliance was highest for PCI patients (71.5%), followed by CABG patients (65.1%), then no-intervention patients (62.1%).

    “Defect-free (100%) compliance was highest for PCI patients (71.5%), followed by CABG patients (65.1%), then no-intervention patients (62.1%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [556] Hiratzka, 2007, Atherosclerosis secondary prevention performance measures after coronary bypass graft surgery compared with percutaneous catheter intervention and nonintervention patients in the Get With the Guidelines database, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Only 30% of eligible patients in Europe participate in a rehabilitation programme after a cardiac event, with considerable variation between countries.

    “The participation rate in a rehabilitation programme after a cardiac event is far lower than desirable: only 30% of eligible patients in Europe participate in such a programme, with considerable variation reported between countries.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Kotseva, 2009, Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Cardiac rehabilitation is considered cost-effective after an acute coronary event; it improves prognosis by reducing recurrent hospitalizations and healthcare expenditure while prolonging life.

    “Cardiac rehabilitation is considered a cost-effective intervention following an acute coronary event; it improves prognosis by reducing recurrent hospitalizations and healthcare expenditure while prolonging life.562”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [562] Jolliffe, 2001, Exercise-based rehabilitation for coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the same RCT, the intensive intervention reduced clinical endpoints: cardiovascular mortality, non-fatal myocardial infarction, and stroke by 33% (P=0.02); cardiac death plus non-fatal myocardial infarction by 36% (P=0.02); total stroke by 32%; and total mortality by 21% (not significant).

    “Clinical endpoints were also reduced by the intensive intervention: cardiovascular mortality, non-fatal myocardial infarction, and stroke by 33% (P ¼ 0.02), and cardiac death plus non-fatal myocardial infarction by 36% (P ¼ 0.02), total stroke by 32%, and total mortality by 21% (P ¼ not significant).565”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [565] Giannuzzi, 2008, Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A low-intensity quality-improvement programme in a randomized national study of 458 hospitals after bypass surgery significantly increased optimal secondary prevention, with better adherence in all patient subgroups, particularly women and the elderly, and almost eliminated previous treatment gaps.

    “A significant increase was observed in the rate of optimal secondary prevention, with better adherence to guidelines in all patient subgroups, particularly women and the elderly; previously existing treatment gaps were almost eliminated, and improvements were seen in the use of lipid-lowering therapy, ACE inhibitor treatment, and tobaccocessation counselling.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [560] Williams, 2011, Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A 3-year multicentre RCT found that a long-term, reinforced, multifactorial educational and behavioural intervention coordinated by a cardiologist after standard cardiac rehabilitation improved risk factors and increased medication adherence over time, with significant improvement in lifestyle habits.

    “The intervention proved effective in improving risk factors and increasing medication adherence over time, with significant improvement in lifestyle habits (i.e.exercise, diet, psychosocial stress, and body weight).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [565] Giannuzzi, 2008, Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In randomized studies with a structured treatment regimen and frequent follow-up after ACS, the compliance rate is high and the event rate is low.

    “In randomized studies with a structured treatment regimen and frequent follow-up following an ACS, the compliance rate is high and the event rate low.561”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [561] Rauch, 2010, OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Self-help groups increase independence and improve quality of life.

    “Self-help groups increase independence and improve quality of life.”
    Quote in the paperNot a substantial claim
303 of 303

  • The paper relies on this without support.

    Risk is a continuum and there is no threshold at which a drug is automatically indicated.

    “thresholds to trigger certain interventions are problematic since risk is a continuum and there is no threshold at which, for example, a drug is automatically indicated.”

  • The paper relies on this without support.

    Treatment of periodontitis improves endothelial dysfunction, one of the earliest signs of atherosclerosis.

    “Treatment of periodontitis improves endothelial dysfunction, one of the earliest signs of atherosclerosis.”

  • The paper relies on this without support.

    Detecting asymptomatic but diseased patients is crucial for an adequate prevention programme.

    “Detection of asymptomatic but diseased patients is crucial for an adequate prevention programme.”

  • The paper relies on this without support.

    Management of all risk factors in diseases with increased cardiovascular risk is advisable even without randomized studies.

    “Management of all risk factors appears advisable even in the absence of randomized studies.”

  • The paper relies on this without support.

    Motivation is the most important predictor of successful smoking cessation and can be increased by professional assistance.

    “The most important predictor of successful quitting is motivation, which can be increased by professional assistance.”

  • The paper relies on this without support.

    The momentum for smoking cessation is particularly strong at the time of diagnosing CVD and in connection with invasive treatment such as CABG, percutaneous transluminal coronary angioplasty, or vascular surgery.

    “The momentum for smoking cessation is particularly strong at the time of diagnosing CVD and in connection with an invasive treatment such as CABG, percutaneous transluminal coronary angioplasty, or vascular surgery.”

  • The paper relies on this without support.

    Smoking cessation leads to average weight gain of about 5 kg.

    “Smokers should be advised about expected weight gain of on average 5 kg and that the health benefits of tobacco cessation far outweigh the risks from weight gain.”

  • The paper relies on this without support.

    Long-term safety and efficacy data for all pharmacological smoking-cessation therapies are lacking.

    “All pharmacological smoking-cessation therapies should be used short term since long-term safety and efficacy data are lacking.”

  • The paper relies on this without support.

    Support from partner and family is very important, and getting other family members who smoke to quit together with the patient is of great help.

    “Support from the partner and family is very important.Getting other family members who smoke to quit together with the patient is of great help.”

  • The paper relies on this without support.

    Dietary habits influence cardiovascular risk through effects on risk factors such as serum cholesterol, BP, body weight, and diabetes, or independently of these risk factors.

    “Dietary habits are known to influence cardiovascular risk, either through an effect on risk factors such as serum cholesterol, BP, body weight, and diabetes, or through an effect independent of these risk factors.”

  • The paper relies on this without support.

    A healthy diet reduces the risk of other chronic diseases such as cancer.

    “A healthy diet also reduces the risk of other chronic diseases such as cancer.”

  • The paper relies on this without support.

    In CVD prevention, the fatty acid composition of the diet is more important than total fat content.

    “In prevention, the fatty acid composition of the diet is more important than the total fat content.”

  • The paper relies on this without support.

    Polyunsaturated fatty acids lower LDL cholesterol and, to a lesser extent, HDL cholesterol when they replace saturated fatty acids.

    “Polyunsaturated fatty acids lower LDL cholesterol levels, and to a lesser extent HDL cholesterol levels, when they replace saturated fatty acids.”

  • The paper relies on this without support.

    Trans fatty acids increase total cholesterol and decrease HDL cholesterol.

    “The subclass of unsaturated fatty acids with a so-called 'trans configuration', the trans fatty acids, have been shown to increase total cholesterol and decrease HDL cholesterol levels.”

  • The paper relies on this without support.

    The impact of dietary cholesterol on serum cholesterol is weak compared with that of fatty acid composition.

    “The impact of dietary cholesterol on serum cholesterol levels is weak compared with that of the fatty acid composition of the diet.”

  • The paper relies on this without support.

    The effect of sodium intake on BP is well established.

    “The effect of sodium intake on BP is well established.”

  • The paper relies on this without support.

    Higher potassium intake reduces BP.

    “A higher potassium intake has been shown to reduce BP.”

  • The paper relies on this without support.

    Case-control and prospective observational studies observed inverse associations between vitamin A and E levels and CVD risk.

    “Many case -control and prospective observational studies have observed inverse associations between levels of vitamin A and E and risk of CVDs.”

  • The paper relies on this without support.

    Consumption of dietary fibre reduces the risk of CVD.

    “Consumption of dietary fibre reduces the risk of CVD.”

  • The paper relies on this without support.

    Observational studies show a protective effect of fruit and vegetable consumption on CVD prevention.

    “Observational studies have shown a protective effect of consumption of fruits and vegetables on CVD prevention.”

  • The paper relies on this without support.

    Results from epidemiological studies show a protective effect of moderate alcohol consumption on CVD occurrence.

    “Results from epidemiological studies show a protective effect of moderate alcohol consumption on the occurrence of CVD.”

  • The paper relies on this without support.

    The relationship between alcohol consumption and CVD is J-shaped, not explained by special characteristics of abstainers.

    “The relationship is J-shaped, which is not explained by special characteristics of abstainers.”

  • The authors state this as an assumption.

    An intake of 30–45 g/day of fibre is assumed to be the optimal preventive level.

    “This intake is assumed to be the optimal preventive level.”

  • The paper relies on this without support.

    After multivariable adjustment, raised blood cholesterol and reduced HDL cholesterol remain independently associated with risk, while the association between weight and risk tends to lose significance.

    “Raised blood cholesterol and reduced HDL cholesterol levels remain independently associated with risk after adjustment for other major risk factors, whereas the association between weight and risk tends to lose significance.”

  • The paper relies on this without support.

    Increasing BMI is highly associated with risk of CVD.

    “Increasing BMI is highly associated with risk of CVD.”

  • The paper relies on this without support.

    Diet, exercise, and behaviour modifications are mainstay therapies for overweight and obesity but are often unsuccessful for long-term treatment.

    “Although diet, exercise, and behaviour modifications are the mainstay therapies for overweight and obesity (Table 12), they are often unsuccessful for long-term treatment.”

  • The paper relies on this without support.

    Major issues in bariatric surgery are lack of consensus on available procedures and need for technique refinement to decrease associated risks.

    “The major issues in the field of bariatric surgery are the lack of consensus in terms of the diverse procedures available and of the refinement of techniques that will evolve to decrease the associated risks.”

  • The paper relies on this without support.

    Individuals with elevated BP more commonly have other CVD risk factors (diabetes, insulin resistance, dyslipidaemia) and target organ damage.

    “Individuals with an elevated BP more commonly have other risk factors for CVD (diabetes, insulin resistance, dyslipidaemia) and target organ damage.”

  • The paper relies on this without support.

    Ambulatory and home BP monitoring allow diagnosis of white coat or isolated clinic hypertension and masked hypertension.

    “They also allow two specific clinical conditions to be diagnosed, namely 'white coat' or isolated clinic hypertension characterized by higher office BP with normal ambulatory BP values, and 'masked' hypertension characterized by normal office BP with high ambulatory BP values.417”

  • The paper relies on this without support.

    BP thresholds for definition of hypertension by 24-h ambulatory and home BP monitoring differ from office or clinic measurements.

    “BP thresholds for the definition of hypertension by 24-h ambulatory and home BP monitoring differ from those measured at office or clinic (Table 14).”

  • The paper relies on this without support.

    Diagnosis of hypertension and assessment of treatment are still largely based on office or clinic blood pressure.

    “Diagnosis of hypertension and assessment of treatment are still largely based on office or clinic blood pressure.”

  • The paper relies on this without support.

    Established cardiovascular or renal disease dramatically increases risk of subsequent cardiovascular events regardless of BP level.

    “Established cardiovascular or renal disease (Table 15) dramatically increases the risk of subsequent cardiovascular events regardless of BP level.”

  • The paper relies on this without support.

    Association of hypertension and other cardiovascular risk factors, especially diabetes, also dramatically increases risk.

    “This is also the case for the association of hypertension and other cardiovascular risk factors, not least diabetes.”

  • The paper relies on this without support.

    Echocardiography is more sensitive than electrocardiography in diagnosing LVH and predicting cardiovascular risk, and may help in more precise risk stratification and directing therapy.

    “Echocardiography is more sensitive than electrocardiography in diagnosing LVH and in predicting cardiovascular risk, and may help in more precise stratification of the overall risk and in directing therapy.”

  • The paper relies on this without support.

    Ultrasound scans limited to common carotid arteries are likely to detect vascular hypertrophy only, whereas assessment of atherosclerosis also requires scanning bifurcations and/or internal carotids where plaques are more frequent.

    “Ultrasound scans limited to the common carotid arteries (an infrequent site of atherosclerosis) are likely to detect vascular hypertrophy only, whereas assessment of atherosclerosis also requires scanning of bifurcations and/or internal carotids where plaques are more frequent.”

  • The paper relies on this without support.

    Evidence of arterial damage may also be suggested by an ABI <0.9.

    “Evidence of arterial damage may also be suggested by an ABI ,0.9.”

  • The paper relies on this without support.

    A threshold >12 m/s has been suggested as a conservative estimate of significant alterations of aortic function in middle-aged hypertensive patients.

    “Although the relationship between aortic stiffness and events is continuous, a threshold .12m/s has been suggested as a conservative estimate of significant alterations of aortic function in middle-aged hypertensive patients.”

  • The paper relies on this without support.

    Diagnosis of hypertension-induced renal damage is based on reduced renal function and/or elevated urinary albumin excretion.

    “The diagnosis of hypertension-induced renal damage is based on the finding of a reduced renal function and/or the detection of elevated urinary albumin excretion.”

  • The paper relies on this without support.

    Renal insufficiency is classified according to eGFR calculated using MDRD, Cockcroft-Gault, or CKD-EPI.

    “Renal insufficiency is classified according to the eGFR calculated using the MDRD, Cockroft-Gault formula, or CKD-EPI.”

  • The paper relies on this without support.

    The three formulae help detect mildly impaired renal function, particularly if serum creatinine is within normal range and body weight low and/or age advanced.

    “The three formulae help to detect mildly impaired renal function, particularly if serum creatinine values are still within the normal range and the body weight low and/or the age advanced.”

  • The paper relies on this without support.

    Microalbuminuria can be measured from spot urine samples by indexing urinary albumin to creatinine; 24-h or night-time urine samples are discouraged due to inaccuracy.

    “Microalbuminuria can be measured from spot urine samples (24-h or night-time urine samples are discouraged due to the inaccuracy of urinary sample collection) by indexing the urinary albumin concentration to the urinary creatinine concentration.”

  • The paper relies on this without support.

    A delay in achieving blood pressure control in high-risk hypertensive patients is associated with a worse outcome.

    “A delay in achieving BP control in high-risk hypertensive patients is associated with a worse outcome.”

  • The paper relies on this without support.

    In high-risk hypertensive patients, even intense cardiovascular drug therapy cannot lower total cardiovascular risk below the high-risk threshold.

    “This is because, in high-risk hypertensive patients, even intense cardiovascular drug therapy-although beneficialcannot lower total cardiovascular risk below the high-risk threshold.”

  • The paper relies on this without support.

    Tobacco smoking has a particularly adverse effect on cardiovascular risk.

    “As tobacco smoking has a particularly adverse effect on cardiovascular risk”

  • The paper relies on this without support.

    Long-term compliance with lifestyle changes may be poor.

    “As long-term compliance with lifestyle changes may be poor”

  • The paper relies on this without support.

    In type 2 diabetes, LDL cholesterol often remains within the normal range or is just moderately elevated, while a major CVD risk factor is diabetic dyslipidaemia characterized by hypertriglyceridaemia and low HDL cholesterol.

    “However, it has to be stressed that in patients with type 2 diabetes, LDL cholesterol often remains within the normal range or is just moderately elevated, while one of the major CVD risk factors in these patients is diabetic dyslipidaemia characterized by hypertriglyceridaemia and low HDL cholesterol.”

  • The paper relies on this without support.

    There are no randomized trials providing sufficient evidence to derive target levels for triglycerides.

    “There are, however, no randomized trials to provide sufficient evidence to derive target levels for triglycerides.”

  • The paper relies on this without support.

    There is insufficient scientific evidence for any HDL cholesterol value to be considered a goal of therapy.

    “However, there is still not sufficient scientific evidence for any HDL cholesterol value to be considered as a goal of therapy”

  • The paper relies on this without support.

    The cardiovascular risk associated with hypertriglyceridaemia is stronger for moderate than for very severe hypertriglyceridaemia (>10 mmol/L or 900 mg/dL).

    “The risk is associated more strongly with moderate than with very severe hypertriglyceridaemia (.10 mmol/L or 900 mg/dL)”

  • The paper relies on this without support.

    Very severe hypertriglyceridaemia (>10 mmol/L or 900 mg/dL) is a risk factor for pancreatitis.

    “which is on the other hand a risk factor for pancreatitis.”

  • The paper relies on this without support.

    Fasting triglycerides above 1.7 mmol/L (150 mg/dL) are a marker of increased cardiovascular risk.

    “At present, fasting triglycerides .1.7 mmol/L ( 150 mg/dL) continue to be considered as a marker of increased risk”

  • The paper relies on this without support.

    Measuring non-fasting triglycerides lacks standardization.

    “However, due to the lack of standardization, measuring non-fasting triglycerides is not recommended.”

  • The paper relies on this without support.

    The combination of moderately elevated triglycerides and low HDL cholesterol is very common in high-risk patients with type 2 diabetes, abdominal obesity, insulin resistance, and physical inactivity.

    “The combination of moderately elevated triglycerides and low concentrations of HDL cholesterol is very common in high-risk patients with type 2 diabetes, abdominal obesity, insulin resistance, and who are physically inactive.”

  • The paper relies on this without support.

    This combination is part of a pattern of deranged plasma lipoproteins characterized by increased triglycerides, small dense LDL particles, and low HDL cholesterol.

    “It is part of a pattern of deranged plasma lipoproteins characterized by a triad of increased triglycerides, the presence of small, dense, and very atherogenic LDL particles, and low concentrations of HDL cholesterol.”

  • The paper relies on this without support.

    HDL cholesterol below 1.0 mmol/L in men and below 1.2 mmol/L in women may be regarded as a marker of increased risk.

    “although HDL cholesterol ,1.0 mmol/L ( 40 mg/dL) in men and ,1.2 mmol/L ( 45 mg/dL) in women may be regarded as a marker of increased risk.”

  • The paper relies on this without support.

    Measurement of apolipoproteins is not available to all physicians in Europe, is more costly than currently used lipid variables, and does not add more information.

    “As the measurement of apolipoproteins is not available to all physicians in Europe, is more costly than currently used lipid variables, and does not add more information”

  • The paper relies on this without support.

    Secondary dyslipidaemias can be caused by alcohol abuse, diabetes, Cushing's syndrome, liver and kidney diseases, and several drugs.

    “Secondary dyslipidaemias can also be caused by alcohol abuse, diabetes, Cushing's syndrome, diseases of the liver and kidneys, and several drugs (e.g.corticosteroids, isotretinoin and etretinate, cyclosporin).”

  • The paper relies on this without support.

    Treatment of underlying disease often improves hyperlipidaemia and may make other antilipaemic therapy unnecessary.

    “as often the treatment of underlying disease improves hyperlipidaemia and no other antilipaemic therapy is necessary.”

  • The paper relies on this without support.

    Dyslipidaemia is common in organ transplant patients due to underlying disease, lifestyle, and treatments including immunosuppressive therapy.

    “Dyslipidaemia is common in patients who have undergone organ transplantation due to a combination of factors relating to the underlying disease, lifestyle, and treatments, including immunosuppressive therapy.”

  • The paper relies on this without support.

    5-10% of patients receiving statins develop myopathy, but rhabdomyolysis is extremely rare.

    “5-10% of patients receiving statins develop myopathy, but rhabdomyolysis is extremely rare.”

  • The paper relies on this without support.

    The safety profile of statins is acceptable, and earlier observations that lipid-lowering treatment may increase non-cardiovascular mortality or mental disorders have not been confirmed.

    “In general, the safety profile of statins is acceptable, and earlier observations that lipid-lowering treatment may contribute an increase in non-cardiovascular mortality (e.g.cancers, suicides, depression) or mental disorders have not been confirmed.”

  • The paper relies on this without support.

    Bile acid sequestrants decrease total and LDL cholesterol but tend to increase triglyceride concentrations.

    “Bile acid sequestrants also decrease total and LDL cholesterol but tend to increase triglyceride concentrations.”

  • The paper relies on this without support.

    Combinations of a statin and a bile acid sequestrant or a statin and ezetimibe can achieve greater LDL cholesterol reduction than either drug alone.

    “Combinations of a statin and a bile acid sequestrant or a combination of a statin and ezetimibe can be used for greater reduction of LDL cholesterol than can be achieved with either drug alone.”

  • The paper relies on this without support.

    Combinations of niacin and a statin increase HDL cholesterol and decrease triglycerides better than either drug alone, but flushing is the main adverse effect of niacin, which may affect compliance.

    “Combinations of niacin and a statin increase HDL cholesterol and decrease triglycerides better than either of these drugs alone, but flushing is the main adverse effect of niacin, which may affect compliance.”

  • The paper relies on this without support.

    Adding laropiprant to niacin might help reduce the incidence of flushing.

    “Adding laropiprant to niacin might help in reducing the incidence of this adverse effect.”

  • The paper relies on this without support.

    Fibrates, particularly fenofibrate, may be useful for decreasing high triglycerides and increasing low HDL cholesterol, and can further lower LDL cholesterol when combined with a statin.

    “Fibrates, particularly fenofibrate, may be useful, not only for decreasing high triglyceride concentrations and increasing low HDL cholesterol, but can further lower LDL cholesterol when applied together with a statin.”

  • The paper relies on this without support.

    Stroke is the most serious complication of atrial fibrillation.

    “Stroke is the most serious complication of AF.”

  • The paper relies on this without support.

    Atrial fibrillation is often unrecognized and untreated in patients admitted with acute ischaemic stroke.

    “AF is often unrecognized and untreated in patients admitted with acute ischaemic stroke.”

  • The paper relies on this without support.

    Cost-related medication non-adherence is a relevant problem in many healthcare systems, especially in the elderly and people of low socio-economic status.

    “Cost-related medication non-adherence is a relevant problem in many healthcare systems, especially in the elderly and people of low socio-economic status.”

  • The paper relies on this without support.

    Cardiovascular disease is the single most important cause of death for both men and women and can often be prevented.

    “Cardiovascular disease is the single most important cause of death for both men and women and can often be prevented!”

  • The paper relies on this without support.

    After a cardiovascular event, secondary preventive efforts within a structured rehabilitation programme have been shown to be particularly important and cost-effective.

    “After a cardiovascular event, secondary preventive efforts within a structured rehabilitation programme have been shown to be particularly important and cost-effective.”

  • The paper relies on this without support.

    Smoking bans in public places, by law, lead to a decrease in incidence of myocardial infarction.

    “Smoking bans in public places, by law, lead to a decrease in incidence of myocardial infarction.”

  • The paper relies on this without support.

    Microalbuminuria is a risk factor for cardiovascular disease, rising progressively from normal GFR to end-stage renal disease.

    “Microalbuminuria is a risk factor for CVD, which rises progressively from a normal GFR to end-stage renal disease.”

  • The paper relies on this without support.

    Effective prevention programmes are undeniably needed.

    “However, the need for effective prevention programmes is undeniable, and the evidence shows that nurses can successfully lead or co-ordinate such schemes in a variety of settings.”

  • The paper relies on this without support.

    General practitioners are critical to the implementation and success of CVD prevention programmes in Europe.

    “General practitioners are critical to the implementation and success of CVD prevention programmes in Europe.”

  • The paper relies on this without support.

    In most countries, general practitioners deliver more than 90% of consultations and provide most public health medicine.

    “In most countries, they deliver .90% of consultations and provide most public health medicine (preventive care, disease screening, chronic disease monitoring, and follow-up).”

  • The paper relies on this without support.

    Primary prevention of CVD performs worse at least partly because it is more difficult to predict who is at greater risk and may benefit from treatment.

    “The performance of primary prevention of CVD is even worse, at least partly because of additional difficulties in predicting those at greater risk who may benefit from treatment interventions.”

  • The paper relies on this without support.

    Most cases of CVD are preventable through lifestyle changes and appropriate use of medications already in existence.

    “It was concluded that most cases of CVD are preventable through lifestyle changes and appropriate use of medications already in existence.”
78 of 78

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • According to practice guidelines in place at the time of patient enrollment in IMPROVE-IT, treatment of hypercholesterolemia was based on lowering LDL cholesterol to target levels, which were set on the basis of a patient's risk of cardiovascular events.

    “According to practice guidelines in place at the time of patient enrollment in IMPROVE-IT, treatment of hypercholesterolemia was based on lowering LDL cholesterol to target levels, 20,21 which were set on the basis of a patient's risk of cardiovascular events.”

    From Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes (2015) · cites this paper as [21]

  • Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk individuals with previous MI or stroke (secondary prevention).

    “Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk individuals with previous MI or stroke (secondary prevention) and is strongly recommended.”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [174]

  • For people with documented ASCVD, use of aspirin for secondary prevention has far greater benefit than risk.

    “For people with documented ASCVD, use of aspirin for secondary prevention has far greater benefit than risk; for this indication, aspirin is still recommended (174).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [174]

  • The 2012 and 2016 European Guidelines on CVD prevention recommend SCORE because it rests on large representative European cohort data and is relatively easy to recalibrate for individual countries.

    “The European Guidelines on CVD prevention in clinical practice (both the 2012 [9] and 2016 [10] versions) recommend the use of the SCORE system because it is based on large, representative European cohort data sets and because it is relatively straightforward to recalibrate for individual countries.”

    From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [9]

  • In primary prevention among people without prior cardiovascular events, aspirin's net benefit is controversial.

    “In primary prevention, however, among patients with no previous cardiovascular events, its net bene fi t is more controversial (129,140).”

    From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [140]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting blood-pressure threshold for starting treatment in diabetes

    Major

    One section says to initiate antihypertensive treatment in diabetes at ≥140/90 mmHg; the diabetes section says ≥140/80 mmHg. These thresholds give different treatment decisions for a patient whose systolic pressure is at least 140 and diastolic pressure is between 80 and 89 mmHg.

1 of 1

Cites

3 retracted

Flagged first, then by citations

Research works printed but not linked: 24

  1. SIGN (Scottish Intercollegiate Guidelines Network), 2007, Risk Estimation and the Prevention of Cardiovascular Disease. A National Clinical Guideline
  2. World Health Organization, 2002, Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases
  3. World Health Organization, Regional Office for Europe, 1973, The Prevention and Control of Major Cardiovascular Diseases. Report of a Conference
  4. Tunstall-Pedoe H (World Health Organization), 2003, MONICA Monograph and Multimedia Sourcebook
  5. Vander Stichele, 2008, Is the decline in coronary attack rates leveling off in Flanders?, Eur J Cardiovasc Prev Rehabil, 15 suppl 1, S1
  6. National Institute for Health and Clinical Excellence, 2010, Prevention of Cardiovascular Disease: Costing Report
  7. Cooney, 2009, How much does HDL cholesterol add to risk estimation? A report from the SCORE investigators, Eur J Cardiovasc Prev Rehabil, 16, 304, 10.1097/hjr.0b013e3283213140 · DOI · Paper page
  8. Cooney, 2009, HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk, Atherosclerosis, 206, 611, 10.1016/j.atherosclerosis.2009.02.041 · DOI · Paper page
  9. World Health Organization, Global Health Observatory Data Repository
  10. Fajardo, 1999, Is the pathology of radiation injury different in small vs large blood vessels?, Cardiovasc Radiat Med, 1, 108
  11. Thun, 1997, Age and the exposure–response relationships between cigarette smoking and premature death in Cancer Prevention Study II, 383
  12. Center for Disease Control and Prevention, 2010, How Tobacco Smoke Causes Disease: The Biology and Behavioural Basis for Smoking-attributable Disease
  13. WHO Study Group on Tobacco Product Regulation TobReg, 2005, Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators
  14. International Agency for Research on Cancer, 2007, Tobacco Control: Reversal of Risk After Quitting Smoking. IARC Handbooks of Cancer Prevention
  15. National Institute for Health and Clinical Excellence, 2008, NICE Public Health Guidance 10. Smoking Cessation Services in Primary Care, Pharmacies, Local Authorities and Workplaces, Particularly for Manual Working Groups, Pregnant Women and Hard to Reach Communities
  16. European Heart, 2011, Diet, Physical Activity and Cardiovascular Disease Prevention in Europe
  17. Abuannadi, 2011, Give me sunshine: vitamin D cardiovascular health, Prim Care Cardiovasc J, 4, 59
  18. US Department of Health and Human Services, 2008, Physical Activity Guidelines Advisory Committee Report
  19. US Department of Health and Human Services, 2008, 2008 Physical Activity Guidelines for Americans
  20. World Health Organization, 1998, Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation, World Health Organization Technical Report Series
  21. Lohman, 1998, Anthoropometric Standardization Reference Manual
  22. Antithrombotic Trialists' Collaboration, 2002, Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients, BMJ, 324, 71, 10.1136/bmj.324.7329.71 · DOI · Paper page
  23. Liu, 2000, Anticoagulants for preventing recurrence following ischaemic stroke or transient ischaemic attack, Cochrane Database Syst Rev, 2
  24. Wood, 2007, Clinical reality of coronary prevention in Europe: a comparison of EUROPASPIRE I, II, and III surveys. Paper presented at, The 29th Annual Congress of the European Society of Cardiology

Cited by

Sorted by citations

Related

Authors
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., Cifkova, R., Deaton, C., Ebrahim, S., Fisher, M., Germano, G., Hobbs, R., Hoes, A., Karadeniz, S., Mezzani, A., Prescott, E., Ryden, L., Scherer, M., Syvänne, M., Scholte Op Reimer, W. J. M., Vrints, C., Wood, D., Zamorano, J. L., Zannad, F., guidelines:, O. E. W. C. T. P. O. T., Cooney, M. T., ESC Committee for Practice Guidelines (CPG):, Bax, J., Baumgartner, H., Ceconi, C., Dean, V., Deaton, C., Fagard, R., Funck-Brentano, C., Hasdai, D., Hoes, A., Kirchhof, P., Knuuti, J., Kolh, P., McDonagh, T., Moulin, C., Popescu, B. A., Reiner, Ž., Sechtem, U., Sirnes, P. A., Tendera, M., Torbicki, A., Vahanian, A., Windecker, S., Reviewers:, D., Funck-Brentano, C., Sirnes, P. A., Aboyans, V., Ezquerra, E. A., Baigent, C., Brotons, C., Burell, G., Ceriello, A., De Sutter, J., Deckers, J., Del Prato, S., Diener, H.-C., Fitzsimons, D., Fras, Z., Hambrecht, R., Jankowski, P., Keil, U., Kirby, M., Larsen, M. L., Mancia, G., Manolis, A. J., McMurray, J., Pająk, A., Parkhomenko, A., Rallidis, L., Rigo, F., Rocha, E., Ruilope, L. M., van der Velde, E., Vanuzzo, D., Viigimaa, M., Volpe, M., Wiklund, O., & Wolpert, C.
Affiliations
  • Linnaeus University (SE)
  • 1 Societies: 1European Society of Cardiology (ESC)
  • European Society of Cardiology (FR)
  • European Society of Hypertension (IT)
  • 5 European Society of Hypertension (ESH)
  • European Association for the Study of Diabetes (DE)
  • 6 European Association for the Study of Diabetes (EASD)
  • European Heart Network (BE)
Corresponding author
Authors/Task Force Members:
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2012-05-03
Volume
33
Issue
13
Pages
1635-1701
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehs092
OpenAlex
W3021842026
Cited by
8,490
References
868
Citations by year
2026: 29 · 2025: 94 · 2024: 237 · 2023: 331 · 2022: 409 · 2021: 740 · 2020: 895 · 2019: 837 · 2018: 799 · 2017: 802 · 2016: 694 · 2015: 684 · 2014: 693 · 2013: 561 · 2012: 329
FWCI
700.71
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • ORBi (University of Liège) (submittedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
Funders
Wellcome Trust (084674)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
cardiovascular disease prevention, cardiovascular risk management, primary prevention, secondary prevention, cardiovascular risk assessment
MeSH terms
Smoking Prevention, Adult, Aged, Antihypertensive Agents, Blood Pressure, Cardiology, Cardiovascular Agents, Cardiovascular Diseases, Chronic Disease, Delivery of Health Care, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diagnostic Imaging, Diet, Drug Combinations, Female, Health Promotion, Hospitalization, Humans, Hypercholesterolemia, Hypertension, Life Style, Lipids, Male, Middle Aged, Obesity, Physician's Role, Primary Health Care, Prognosis, Self Care, Smoking, Socioeconomic Factors, Stress, Psychological, Biomarkers, Exercise, Smoking Cessation, Risk Assessment, Patient Selection, Evidence-Based Medicine, Nurse's Role, Risk Reduction Behavior, Early Diagnosis, Medication Adherence, Electronic Health Records, General Practice

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review