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ESC guidelines on chronic coronary syndromes focus on lifestyle

Prof. Juhani Knuuti
ESC 2019
The new 2019 ESC Guidelines Chronic Coronary Syndromes strongly focus on lifestyle and its influence on the risk of developing coronary disease. Interestingly, this applies not only to the individual patient but also to governments and politicians as they need to take measures to prevent air pollution and noise reduction.

General lifestyle is addressed extensively in the new guidelines, consisting of advice to stop smoking as well as avoid passive smoking, consuming a healthy diet (high in vegetables, fruit, and whole grains), alongside maintaining or working towards a healthy body weight. Moderate physical activity of 30 to 60 minutes on most days is also encouraged as is an annual flu vaccination for elderly patients. Simple as this advice may sound, every healthcare professional knows that changing or adopting a different lifestyle can be incredibly difficult for patients. As patients with coronary artery disease run a 2-fold higher risk of mood and anxiety disorders than individuals without the condition, this may further complicate matters. Counselling can support those patients in making positive changes and is encouraged by the new guidelines. Cognitive behavioural therapy may also be valuable in this respect. Many types of support are available to help patients achieve their goals; these involve not only doctors but also physiotherapists, dietitians, psychologists, and pharmacists.

Attention is also given to air pollution and environmental noise as they increase the risk of heart attack and stroke. “For patients, this means that they should avoid areas that suffer heavy traffic congestion,” advised Prof. Juhani Knuuti, Chairperson of the guidelines Task Force [1]. “If this is not entirely possible, they could consider wearing a respirator face mask outside. For inside prevention, air purifiers with high efficiency particulate air filters can be used to reduce indoor pollution.” However, it is not just the patient who needs to act. Prof. Knuuti stated that minimising both air pollution and environmental noise –and thus their negative effects on health– is a task for governments through policies and regulations.

1. Knuuti J, et al. 2019 ESC Guidelines on Chronic Coronary Syndromes. FP Number 1055. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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