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For all other aspects concerning the management of patients with diabetes, we refer to the recommendations from diabetes associations, e.g. the European Association for the Study of Diabetes (EASD) or the American Diabetes Association (ADA).[1] These Guidelines offer evidence-based recommendations to manage CV risk in patients with diabetes and provide guidance for the treatment of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes. The impact of diabetes on peripheral atherosclerosis Diabetes is one of the most important risk factors for the development and progression of atherosclerosis.[[749], [751], [753]] The number of patients with atherosclerosis associated with diabetes is steadily increasing alongside the increasing number of patients with diabetes worldwide. There has not been a specific trial on revascularization strategies in patients with diabetes; however, a review of 56 studies including patients with diabetes suggested higher limb-salvage rates after revascularization (78-85% at 1 year) compared with conservative management.[770] Due to disease progression, long-term follow-up is very important in patients with diabetes and LEAD.[771] 10.1.2. [Extracted from the article]

The article discusses a study comparing different cardiovascular disease (CVD) risk prediction models and their implications for treatment recommendations. The study found that individuals with the same risk factor profile can receive different risk estimates depending on the algorithm used. The authors argue that this lack of concordance is a limitation of current risk prediction models and treatment approaches. They also highlight the importance of considering the background level of risk in different populations and the need for country-specific decisions and recommendations regarding screening strategies and treatment thresholds. [Extracted from the article]

The article presents the discussion on guidelines summarizing and evaluating available evidence with the aim of assisting health professionals in proposing the best management strategies. Topics include evaluating the level of implementation of the guidelines being used by the ESC, hospitals, healthcare providers, and professionals; and summary slides, summary cards for non-specialists, and an electronic version for digital applications.

The article presents the discussion on SCORE2 being a risk algorithm estimating 10-year cardiovascular disease (CVD) risk in men and women from different risk regions of Europe including the need for consideration of sex differences in cardiovascular disease risk.

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied., Methods and Results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms., Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study., Methods and Results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses., Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)