JBS 2: S ’ G P C P - heart.bmj.com

1 2005 VOLUME 91 SUPPLEMENT VPrepared by:British Cardiac SocietyBritish Hypertension SocietyDiabetes UKHEART UKPrimary Care Cardiovascular SocietyThe Stroke AssociationJBS 2:JOINTBRITISHSOCIETIES GUIDELINESONPREVENTION OFCARDIOVASCULARDISEASE INCLINICALPRACTICE on December 18, 2020 by guest. Protected by : first published as on 19 December 2005. Downloaded from Figure 1 Joint British Societies cardiovascular disease (CVD) risk prediction chart: non-diabetic men. on December 18, 2020 by guest. Protected by : first published as on 19 December 2005. Downloaded from Formerly British Heart JournalJournal of the British Cardiac SocietyEditorRoger J HallDeputy EditorDavid LefroyCommissioning EditorIain SimpsonSeries Editor,Education in HeartPeter MillsAssociate EditorsAdrian P Banning, Eric Butchart, Keith Channon, Filippo Crea,David Crossman, John L Gibbs, Bernard Iung, Theresa AMcDonagh, Andreas Mu gge, Petros Nihoyannopoulos,Catherine M OttoInternational Advisory BoardChristopher Acar (France)Felicita Andreotti (Italy)Fause Attie (Mexico)Philip Aylward (Australia)Peder Bagger (UK)Suman Bhandari (India)Gary Baxter (UK)George Beller (USA)Martin Bennett (UK)Javier Bermejo (Spain)Michael Burch (UK)Paolo Camici (UK)David Celermajer (NewZealand)Keith Channon (UK)Alfred Cheng (Singapore)Andrew Clark (UK)Jacques Clementy (France)Stuart Cobbe (UK)Lawrence Cohen (USA)Stuart Connolly (Canada)Martin Cowie (UK)Nicolas Danchin (France)Carlo di Mario (UK)Maurice Enriquez-Sarano(USA)

2 Jean-Noel Fabiani (France)Peter Fitzgerald (USA)Keith Fox (UK)R J Gibbons (USA)Paul Grayburn (USA)Julian Gunn (UK)Axel Haverich (Germany)Gerd Heusch (Germany)Pierre Jais (France)Karl Karsch (UK)Juan Carlos Kaski (UK)Sanjiv Kaul (USA)Bernard Keavney (UK)Bruce Keogh (UK)Robert Kloner (USA)Cornelius Kluft (Netherlands)Michel Komajda (France)Chim Choy Lang (Malaysia)Gaetano A Lanza (Italy)Christophe Leclercq (France)Malcolm Legget (NewZealand)Gregory Lip (UK)Peter Ludman (UK)Thomas Luscher(Switzerland)Philip MacCarthy (UK)Aldo Maggioni (Italy)Barry Maron (USA)Thomas Marwick (Australia)William McKenna (UK)John McMurray (UK)Bernhard Meier (Switzerland)Neil Moat (UK)Jean-Luc Monin (France)Michael Mullen (UK)Brad Munt (Canada)Andrew Murday (UK)Stefan Neubauer (UK)David Newby (UK)Chris Newman (UK)Sunil Ohri (UK)Dudley Pennell (UK)Philippe Pibarot (Canada)Michael Picard (USA)Bernard Prendergast (UK)Prakash Punjabi (UK)Shahbudin Rahimtoola (USA)Margaret Redfield (USA)Simon Redwood (UK)David Sahn (USA)John Sanderson (Hong Kong)James Scott (UK)Udo Sechtem (Germany)Ajay Shah (UK)Man-Fai Shiu (UK)L David R Smith (UK)Jordi Soler-Soler (Spain)Giuseppe Specchia (Italy)Martin St John Sutton (USA)Christodoulos Stefanadis(Greece)William Stevenson (USA)Kenneth Taylor (UK)James Thomas (USA)Adam Timmis (UK)Eric Topol (USA)Pilar Tornos (Spain)Dimitris Tousoulis (Greece)Alec Vahanian (France)Panos Vardas (Greece)Sami Viskin (Israel)Cees Visser (Netherlands)Nozomi Watanabe ( japan )Hugh Watkins (UK)Gary Webb (Canada)Sylvan Lee Weinberg (USA)Harvey White (New Zealand)William Wijns (Belgium)Junichi Yoshikawa ( japan )Editor:British Medical JournalInstructions to authorsAll papers must be submitted via BenchPress informationSee p v iiCopyrightE2005 BMJ Publishing Group and British Cardiac Society.

3 Allrights reserved; no part of this publication may be reproduced,stored in a retrieval system, or transmitted in any form or byany means, electronic, mechanical, photocopying, recording, orotherwise without prior permissionAuthors are required to grantHeartan exclusive licence topublish; further details available online at published by BMJ Publishing Group, typeset byThe Charlesworth Group, and printed in UK on acid-free paperby Thanet PressNPeriodicals postage paid, Rahway, NJ. Postmaster: sendaddress changes to:Heart, c/o Mercury AirfreightInternational Ltd, 365 Blair Road, Avenel, NJ 07001, USAcontents HEARTV olume 91 Supplement V December 2: Joint British Societies guidelines on preventionof cardiovascular disease in clinical Introductionv8II Objectives and priorities for cardiovascular disease prevention in clinicalpracticev9 III Concept and estimation of total cardiovascular riskv13 IV Clinical assessment of cardiovascular riskV Assessment and management of risk factors for people with establishedCVD and persons at high total risk of developing CVDv17(A) Lifestyle.

4 Smoking, diet, alcohol, physical activity, weight, andbody fat distributionv22(B) Blood pressure and hypertensionv29(C) Blood lipids and dyslipidaemiav40(D) Blood glucose and diabetesv46(E) Other risk factorsv46(F) Ethnicityv47 VI Cardiovascular protective drug therapiesv49 VII Audit standards for CVD preventionVIII Appendicesv51(I) How to use the cardiovascular risk prediction charts for preventionof CVDv52(II) Cardiovascular prevention quality indicators in the new GeneralMedical services contract on December 18, 2020 by guest. Protected by : first published as on 19 December 2005. Downloaded from Formerly British Heart JournalJournal of the British Cardiac SocietyAIMS AND SCOPEH eartis an international journal of cardiology. Clinical cardiology is its centraltheme; however,Heartalso publishes basic science papers with a clear J HallDEPUTY EDITORD avid LefroyCOMMISSIONING EDITORIain SimpsonASSOCIATE EDITORSA drian P Banning, Eric Butchart, Keith Channon, Filippo Crea, David Crossman,John L Gibbs, Bernard Iung, Theresa A McDonagh, Andreas Mu gge, PetrosNihoyannopoulos, Catherine M OttoEDUCATIONINHEARTS eries EditorPeter MillsProject ManagerJohn WellerSection EditorsMartin Cowie, Catherine Dickinson, Pim de Feyter, John L Gibbs, Roger J Hall,Christian Hamm, David Lefroy, Catherine M Otto, Richard Schilling, Alec VahanianJOURNALSCAN EDITORI qbal S MalikSTATISTICAL ADVISORIan FordMANAGING EDITORJ anet O FlahertyTECHNICAL EDITORJohn WellerEDITORIAL ASSISTANTS tephanie WatkinsINTERNATIONAL ADVISORY BOARDSee inside front coverCONTACT DETAILSE ditorial OfficeHeartBMJ Publishing Group LtdBMA HouseTavistock SquareLondon WC1H 9JR, UKTelephone+44 (0) 20 7383 6235 Fax+44 (0)

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7 All rights reserved: no part of this publication may be reproduced, stored in a retrieval system,or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without prior are required to grantHeartan exclusive licence to publish; further details are available online at published by BMJ Publishing Group Ltd and printed in UK on acid free paper by Thanet Press, MargateNPeriodicals postage paid, Rahway, NJ. Postmaster and address changes to: Heart, c/o Mercury Airfreight International Ltd, 363 Blair Road, Avenel, NJ07001, USA on December 18, 2020 by guest. Protected by : first published as on 19 December 2005. Downloaded from JBS 2:Joint British Societies guidelineson prevention of cardiovascular disease inclinical practicePrepared by:British Cardiac SocietyBritish Hypertension SocietyDiabetes UKHEART UKPrimary Care Cardiovascular SocietyThe Stroke Association on December 18, 2020 by guest.

8 Protected by : first published as on 19 December 2005. Downloaded from 2: Joint British Societies guidelines on prevention of cardiovascular disease in clinical practiceThe Joint British Societies guidelines (JBS 2) oncardiovascular disease prevention in clinical practicewere developed by a Working Party (see table) withnominated representatives from six professional societies. Allmembers contributed to the text and those from the specialistsocieties of hypertension, lipids, and diabetes were specifi-cally responsible for developing the sections on bloodpressure, lipids, and glucose. All sections of the documentrepresent an evidence based consensus by all professionalsocieties involved. The scientific literature which informs therecommendations is referenced throughout the text and DrKornelia Kotseva is thanked for all her help in searches forsystematic reviews and meta-analyses, and checking thereferencing of all sections.

9 We are grateful to both Mr HarryHeyes of the Department of Medical Illustration, Universityof Manchester, for the cardiovascular risk prediction chartsartwork, and Mr Daniel Prais of Crawford s BusinessServices, Salford, for the computer programming. Dr PaolaPrimatesta is thanked for providing prevalence estimates oftotal CVD risk in the adult population from the Health Surveyfor England. Mr Tim Collier (Statistician, London School ofHygiene and Tropical Medicine) is also thanked for preparingthe figures on lipid trials. Despoina Xenikaki provided theWorking Party with invaluable administrative support. Thisguideline was reviewed and approved by the boards of all theprofessional 2 Working PartyBritish Cardiac SocietyDavid Wood and Richard WrayBritish Hypertension SocietyNeil Poulter and Bryan WilliamsDiabetes UKMichael Kirby and Vinod PatelHEART UKPaul Durrington and John RecklessPrimary Care CardiovascularSocietyMark Davis and Fran SiversThe Stroke AssociationJohn on December 18, 2020 by guest.

10 Protected by : first published as on 19 December 2005. Downloaded from GUIDELINESJBS 2: Joint British Societies guidelines on prevention ofcardiovascular disease in clinical practiceBritish Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary CareCardiovascular Society, The Stroke ;91(Suppl V):v1 v52. doi: Wood, R Wray,BritishCardiac SocietyN Poulter, B Williams,British HypertensionSocietyM Kirby, V Patel,DiabetesUKP Durrington, J Reckless,HEART UKM Davis, F Sivers,PrimaryCare CardiovascularSocietyJ Potter,The to:Professor David A Wood,Cardiovascular Medicine,National Heart and LungInstitute, Imperial College,Charing Cross Hospital,5th Floor, LaboratoryBlock, Fulham PalaceRoad, London W6 8RF,UK; aim of these new Joint British Societies guidelines (JBS 2) developed by the BritishCardiac Society, British Hypertension Society,Diabetes UK, HEART UK, Primary CareCardiovascular Society, and The StrokeAssociation is to promote a consistent multi-disciplinary approach to the management ofpeople with established atherosclerotic cardio-vascular disease (CVD) and those at high risk ofdeveloping symptomatic atherosclerotic recommend that CVD prevention inclinical practice should focusequallyon(i) people with established atherosclerotic CVD,(ii) people with diabetes, and (iii) apparentlyhealthy individuals at high risk (CVD risk of>20% over 10 years) of developing symptomaticatherosclerotic disease.