World Heart Federation Roadmap for secondary prevention of cardiovascular disease: 2023 update

Liliana Laranjo, Fernando Lanas, Marie Chan Sun, Deborah Anne Chen, Lisa Hynes, Tasnim F Imran, Dhruv S Kazi, Andre Pascal Kengne, Maki Komiyama, Masanari Kuwabara, Jeremy Lim, Pablo Perel, Daniel José Piñeiro, Carlos I Ponte-Negretti, Tania Séverin, David R Thompson, Lale Tokgözoğlu, Lijing L Yan, Clara K Chow

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Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice.

Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management.

Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article’s structure, content, and draft. Finally, an external expert group reviewed the paper.

Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab.

Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

Original languageEnglish
Article number8
Number of pages33
JournalGlobal Heart
Issue number1
Publication statusPublished - 22 Jan 2024

Bibliographical note

Copyright: © 2024 The Author(s).


  • Humans
  • Cardiovascular Diseases/epidemiology
  • Secondary Prevention
  • Risk Factors
  • Diet
  • Health Behavior


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