A strategic objective in the fight against the CVD epidemic must be to ensure early detection and care using cost-effective and sustainable health-care interventions.

High-risk individuals and those with established CVD can be treated with regimens of low-cost generic medicines that significantly reduce the likelihood of death or vascular events. A regimen of aspirin, statin and blood pressure-lowering agents could significantly reduce vascular events in people at high CV risk and is considered a best buy. When coupled with preventive measures such as smoking cessation, therapeutic benefits can be profound. Another best buy is administration of aspirin to people who develop a myocardial infarction (MI). In all countries, these best buys need to be scaled up and delivered through a primary health-care approach [4].

What is needed are high levels of commitment, good planning, community mobilization and intense focus on a small range of critical actions. With these, quick gains will be achieved in reducing the major behavioural risk factors: tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity, together with key risk factors for cancer, notably some chronic infections.

Notable interventions where impact is evident include tobacco tax increases and restrictions on smoking in public places and workplaces; alcohol tax increases and restriction of sales; mandatory and voluntary salt reduction; and improved access to places for physical activity such as walking.

In addressing CVD, the population-wide approach to prevention has great potential to decrease disease burden, but it does not provide an adequate response to the need to strengthen health care for people with CVD. The disease burden can be reduced considerably in the short- to medium-term if the population-wide approach is complemented by health-care interventions for individuals who either already have CVD or those who are at high risk. CVDs can best be addressed by a combination of primary prevention interventions targeting whole populations, by measures that target high-risk individuals and by improved access to essential health-care interventions for people with CVDs [4–7].

For primary prevention of coronary heart disease (CHD) and stroke, individual health-care interventions can be targeted to those at high total CV risk or those with single risk factor levels above traditional thresholds, such as hypertension and hypercholesterolemia [4]. The former approach is more cost effective than the latter and has the potential to substantially reduce CV events [1, 4, 6]. Furthermore, application of this approach is also feasible in primary care in low-resource settings, including by non-physician health workers [8, 9]. It has been estimated that a regimen of aspirin, statin and blood pressure-lowering agents may significantly reduce the risk of death from CVD in people at high cardiovascular risk (people with a 10-year cardiovascular risk equal to or above 15 %, and those who have suffered a previous cardiovascular event). Providing such a regimen to those eligible between 40 and 79 years of age has been estimated to avert about one fifth of cardiovascular deaths in the next 10 years, with 56 % of deaths averted in people younger than 70 years [4].

For secondary prevention of cardiovascular disease (prevention of recurrences and complications in those with established disease), aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and lipid-lowering therapies lower the risk of recurrent cardiovascular events, including in those with diabetes. The benefits of these interventions are largely independent, so that when used together with smoking cessation, about three quarters of recurrent vascular events may be prevented [5].

Currently there are major gaps in the implementation of secondary prevention interventions that can even be delivered in primary care settings [6, 7]. General practitioners are critical to the implementation and success of CVD prevention programmes. In most countries, they deliver the majority of consultations and provide most public health medicine (preventive care, disease screening, chronic disease monitoring, and follow-up). In the case of CVD prevention they have a unique role in identifying individuals at risk of but without established CVD and assessing their eligibility for intervention based on their profile. Thus, the physician in general practice is the key person to initiate, coordinate, and provide long-term follow-up for CVD prevention, while the practising cardiologist should be the advisor in cases where there is uncertainty over the use of preventive medication or when usual preventive options are difficult to apply [6, 7].

Nurse-co-ordinated prevention programmes are also effective across a variety of practice settings and should be well integrated into healthcare systems. Nurse case management models tested in several randomized trials of secondary prevention have shown significant improvements in risk factors, exercise tolerance, glucose control, and appropriate medication use, along with decreases in cardiac events and mortality, regression of coronary atherosclerosis, and improved patient perception of health compared with usual care. Other studies have demonstrated the effectiveness of nurse-led prevention clinics in primary care compared with usual care, with greater success in secondary as opposed to primary prevention [10, 11].

All patients with CVD should be discharged from hospital with clear guideline-orientated treatment modality recommendations to minimize the risk of further adverse events. The new ESC Guidelines provide a check list of measures necessary at discharge from hospital to ensure that intense risk factor modification and lifestyle change are implemented in all patients following the diagnosis of acute coronary syndromes, including recommendation for enrolment in a cardiovascular prevention and rehabilitation programme [7].

After a cardiovascular event, secondary preventive efforts within a structured rehabilitation programme have been shown to be particularly important and cost-effective. Intensive research in the field of preventive cardiology has sustained the evolution of Cardiac Rehabilitation (CR) programs, once limited to exercise training, into comprehensive secondary prevention (SP) centres. CR after cardiac events or interventions in a specialized centre helps to maintain long-term adherence to the optimal treatment programme by educating the patient and repeatedly emphasizing the importance of maintaining the prescribed treatments and recommended lifestyle. Data demonstrate that CR/SP programs reduce cardiovascular risk and event rates, foster healthy behaviours, and promote active lifestyles [12–15].