Background: Selective prevention of cardiometabolic diseases (CMD)-that is, preventive measures specifically targeting the high-risk population-may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.

b Department of General Practice Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands

c Nivel Utrecht the Netherlands

Department of General Practice and Elderly Care Medicine Amsterdam Public Health Research Institute Amsterdam University Medical Centers Amsterdam the Netherlands

e Clinic of Social and Family Medicine School of Medicine University of Crete Greece

f Division of Family Medicine and Primary Care Department of Neurobiology Care Sciences and Society Karolinska Institute Stockholm Sweden

g Department of Medical Sciences Cardiovascular Epidemiology Uppsala University Uppsala Sweden

h Research unit of General Practice Department of Public Health University of Southern Denmark Odense Denmark

Institute of General Practice 1st Faculty of Medicine Charles University Prague Czech Republic

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An evidence-based toolbox for the design and implementation of selective-prevention primary-care initiatives targeting cardio-metabolic disease