gms | German Medical Science

Background/research question: Prioritizing cardiovascular disease (CVD) prevention in primary care is crucial. This research aims to update the current DEGAM guidelines by analyzing national and international guidelines on primary CVD prevention and enhancing a patient-centric approach.

Methods: Following Muth et al.'s approach [1], we conducted a systematic guideline review. We searched databases, including MEDLINE via PubMed, TRIP, guideline repositories, and medical society websites, focusing on primary CVD prevention in adults in evidence-based guidelines from 2016 onwards. Two reviewers independently screened titles, abstracts, and full texts of the guidelines and evaluated them for quality, relevance, and consistency of recommendations. We thematically coded recommendations, their strengths, and evidence levels using ATLAS.ti and categorized them by clinical questions. We applied Muth et al.'s modified approach [1] to assess content consistency. The collected data were tabulated and qualitatively synthesized.

Results: We included 26 guidelines, extracting 581 recommendations on risk assessment, non-pharmacological, and pharmacological interventions. Twenty-one guidelines had "very good" methodological quality; five had minor shortcomings. One-third of recommendations were unrateable (i.e., singular, non-comparable recommendations), with the rest forming 121 clusters. Content, strength, and evidence level alignment varied from high to low consistency; four of 42 consistent recommendations were strong recommendations for or against and had high consistency. These emphasized Mediterranean diet, avoiding routine prescriptions of nicotinic acid, aspirin, and fibrates for primary CVD prevention, and recommending 20mg/day of atorvastatin for high-CVD-risk adults. The recommendations also underscore the need for personalized counselling and standardized risk assessment for patients over the age of 40.

Conclusion: This review highlights the diversity in primary CVD prevention recommendations and the importance of personalized strategies for at-risk individuals over the age of 40. To improve CVD prevention, the use of standardized risk assessment tools is crucial. Challenges related to grading schemes and the transparency of evidence references, despite strong methodological quality, have posed limitations in our analysis.

Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.