Turning secondary prevention into years gained: SMART-REACH2 recalibrates lifetime risk worldwide

The edition in brief

SMART-REACH2, an update of the lifetime risk model the 2021 ESC prevention guideline recommends for patients with established atherosclerotic disease, was derived in 8,708 people and externally validated in 2,085,780 patients from 54 countries (C-statistic 0.68, adequate calibration across risk regions). For an example 50-year-old, lowering systolic pressure by 15 mmHg and LDL cholesterol by 1.0 mmol/L was estimated to add 2 to 4.4 years free of cardiovascular disease, depending on region. The Viborg Screening Program in Denmark invited all 67-year-olds to multi-modality vascular screening; in a propensity-matched comparison, invitees had lower 5-year all-cause mortality (HR 0.76, 95% CI 0.68–0.85; 49 invited per life saved), with benefit concentrated in those without known cardiovascular disease. In 112,395 French adults, higher intake of preservative food additives was associated with more incident hypertension (HR 1.29 for non-antioxidant preservatives) and cardiovascular disease (HR 1.16); this is observational. An AHA scientific statement sets out a team approach to antiplatelet stewardship across care transitions in coronary disease.