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© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved., A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021, Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.

Carotid atherosclerosis is a cause of brain ischemic events. Cardiovascular magnetic resonance (CMR) can assess plaque vulnerability. We investigated atherosclerosis vulnerability in relation to plaque location, eccentricity and vessel remodeling. Methods-Baseline CMR evaluations of the MAGNETIC observational study, were analyzed. We quantitated with MRI-Plaque View™, vessel lumen/wall and vulnerable plaque components of a 32-mm segment of common carotid artery (12 mm), bulb (8 mm) and internal carotid artery (12 mm). Lipid-rich necrotic core [LRNC], fibrous cap [CAP] and intraplaque hemorrhage [IPH] were expressed as percent of wall area. Results-A data-set of 8080 sections of adequate quality in 260 patients (198 male [76%], median age 71 years [65–76]), were analyzed. Patients were on therapy with antiplatelet, ACE-inhibitors/ARB and statins (196–229 out of 260 [75–88%]). We found significant differences in plaque composition according to longitudinal and circumferential location, eccentricity and vessel remodeling (table). At multivariate regression analysis, including classical RF and atherosclerotic burden, we found an independent association of: LRNC and IPH with longitudinal location, eccentricity and positive remodeling, and of CAP with eccentricity (p Lipid-rich necrotic core Fibrous cap Intraplaque hemorrhage Longitudinal distribution Common carotid artery 4% [1–10] p Conclusions Carotid atherosclerotic plaque vulnerability seems to be independently associated with longitudinal location, plaque eccentricity and vessel positive remodeling. Acknowledgement/Funding Bayer AG, Leverkusen, Germany

Aim A low-saturated, low-cholesterol diet is important in the treatment of hypercholesterolaemia in patients with coronary heart disease. The aim of this study was to investigate the efficacy of a very low fat diet to achieve a targeted serum low density lipoprotein (LDL) cholesterol level (≤ 2.59 mmol. l -1 ) in outpatients with coronary heart disease. Methods One hundred and twenty-six male patients (all ex-smokers) with coronary heart disease and a serum LDL cholesterol > 3.37 mmol. l -1 were investigated 12-14 weeks after an acute coronary event. After overnight fasting each patient had (a) his resting energy expenditure measured (indirect calorimetry using standard protocol) and (b) venous blood sampled from a forearm vein to determine lipid profile. All the patients were randomly allocated to four groups of treatment: Group A on a very low fat diet (resting energy expenditure-fat diet, where fat intake was ≤ 20% resting energy expenditure); Group B on a low fat diet from the National Cholesterol Education program (National Cholesterol Education Program step 2 diet); Group C on resting energy expenditure-fat diet+simvastatin 10 mg daily; Group D on National Cholesterol Education Program step 2 diet+simvastatin 10 mg daily. For all patients the prescribed energy intakes were equal to their respective resting energy expenditures. Results At 6 months, the average decrease in serum LDL cholesterol was not different between Group A and Group B, but the increase in high density lipoprotein cholesterol (HDL) (+ 29%) observed in Group A led to a reduced LDL cholesterol/HDL cholesterol ratio (P