**5. Summary**

The main risk factors for cardiovascular atherosclerotic disease are high total and LDL cholesterol, elevated blood pressure, smoking, psychological stress, uncontrolled or poorly controlled diabetes, and obesity. Risk factors are treated based on the goals set by the guidelines.

Regular physical activity is important in secondary prevention.

In general, a reduction of sedentary time and more involvement in activities is recommended for all adults for primary and secondary prevention. Cardiac rehabilitation is encouraged for all patients with established CvAD.

A diet poor in saturated fats and rich in vegetables and fruits lowers the risk of cardiovascular disease.

Maintaining a normal weight may influence favorably other risks such as elevated blood pressure and elevated total and LDL cholesterol, reducing, thus, the CvAD risk.

Mental healthcare, especially management of depression, improves the quality of life and reduces the risk for CvAD.

Stopping smoking reduces the CvAD risk in all persons. Assistance drug therapy and follow-up support should be used to encourage patients to stop smoking if difficulties are observed.

The levels of LDL should be lowered by the use of statins, ezetimibe, and/or PCSK9 inhibitors in all patients with CvAD aiming to achieve the goal of values less than 55 mg/dL (<1.4 mmol/L), or if not achieved, by a reduction of more than 50% compared to baseline.

Lifestyle interventions and antihypertensive drugs, such as beta-blockers, ACE inhibitors, or ARBs, are recommended to lower BP levels based on recent guidelines aiming to achieve levels of 120/80 mmHg or lower.

Antiplatelet therapy with aspirin is indicated in all patients with CvAD. In patients with CvAD and diabetes, treatment of diabetes with a target of 6.5–7.5% HbA1c is recommended.

**Table 7** summarizes the use of cardioprotective medications in CvAD.


### **Table 7.**

*Recommendations for cardioprotective medical therapy in patients with CvAD (ESC guidelines 2021).*
