Primary prevention is the prevention of the first clinical ASCVD in a person without established disease. Secondary prevention is the prevention of a new event in a person with ASCVD. Confusing these two modes is a typical error: "statins for everyone, target 1.4" in primary care without a risk category is just as wrong as "let's watch the cholesterol of 3.2" after myocardial infarction.
Primary. SCORE2/SCORE2-OP is calculated if there are no conditions that by themselves confer high/very high risk. A class I drug — at very high risk and LDL-C ≥1.8 mmol/L or high risk and LDL-C ≥2.6 mmol/L after lifestyle optimisation (ESC/EAS 2025). Below these thresholds a drug may be considered (IIa A) according to Table 4: for example, moderate risk and LDL-C 2.6–4.9 mmol/L. In people with HIV ≥40 years, statins are recommended regardless of the scale (I B). FH is treated as a disease, not as "slightly raised cholesterol".
Secondary. Documented ASCVD (clinically or unequivocally on imaging) = very high risk = high-intensity statin + target <1.4 and −50% + single antiplatelet therapy in CCS without an oral anticoagulant + control of BP, glycaemia, smoking. After ACS, do not wait for an outpatient visit to "add ezetimibe": intensification during the index hospitalisation is the new logic of 2025.
What prevention does not promise. Lowering LDL-C by 1 mmol/L reduces major vascular events by about 22% in relative terms (CTT 2010) — it does not reduce them to zero. Lp(a) cannot yet be "cured" with a proven reduction in events. Fibrates do not replace a statin. Supplements are class III. CAC = 0 lowers the probability but does not grant an indulgence to a smoker with FH.
The boundary of antianginal pharmacology that the course names but does not expand into a regimen: ivabradine in ESC CCS 2024 (Recommendation Table 16) does not replace a statin and is not indicated as add-on therapy with LVEF >40% without clinical HF (III B).
What the course does not cover — a final reminder.
- Acute coronary syndrome as a full protocol.
- Stroke as a full protocol of thrombolysis and thrombectomy.
- Indications for carotid and peripheral revascularisation.
- Management of pregnant women with FH and of children.
- Anti-inflammatory therapy of atherosclerosis (colchicine etc.) as a standard.
- Dietary supplements, "vessel cleansing", laser and other interventions without a guideline evidence base.
Revisions change thresholds. Therefore, in an exam answer, name the edition: ESC/EAS 2019 targets, ESC/EAS 2025 scales and new classes, ESC 2024 CCS, Kazakhstan Ministry of Health protocol No. 196/2023, ESVS 2024 for aneurysm. A number without an edition is not knowledge but a risk of learning a revoked threshold.