Carlos Brotons is a cornerstone of cardiovascular prevention in Europe. A driving force behind Spain’s PAPPS and the first coordinator of EUROPREV, he has spent decades ensuring that Family Medicine has a seat at the table when European clinical guidelines are written. As Co-Chair of the upcoming EUROPREV Forum 2026, we spoke with him about the evolution of prevention, the risks of medicalizing healthy populations, and what to expect in Madrid next month.

The Early Days: Bringing Family Medicine to the Table

Q: You were there at the very beginning of EUROPREV in 1996. What was the original mission?

Carlos Brotons: The original mission of EUROPREV when it was founded was to implement evidence-based preventive and health promotion activities into clinical practice in family medicine. One of the main topics at the beginning was cardiovascular disease prevention. In the early 90s, cardiovascular prevention was fragmented. We had experts in hypertension, lipids, and diabetes—mostly hospital-based—working in silos. At EUROPREV, we wanted to bring a structured, integrated approach directly into the Primary Care clinic. Since 1998, WONCA Europe has designated EUROPREV as the representative body for European cardiovascular guidelines, ensuring that the "GP perspective" is included in every update.

The Evolution of Risk

Q: How has our approach to the "patient in front of us" changed over thirty years?

CB: We have moved from simple coronary risk charts to highly sophisticated tools like SCORE2 and SCORE2-OP for older persons. These are now easily accessible via apps, making evidence-based prevention much more practical for a busy GP. If I had to summarize what this movement has given us in one sentence: It has enabled Primary Care professionals to implement preventive recommendations that are evidence-based, clear, and standardized. In the near future we will move away from population averages toward personalized risk—integrating genomics, proteomics, imaging, information from wearable technologies, integrating all with AI to improve estimation of risk and to reduce both overtreatment and undertreatment."

The Danger of "Low-Value" Practices

Q: You are a vocal advocate for avoiding "low-value" practices. What should we be looking out for?

CB: We often face clinical inertia. For example, many patients still take "baby aspirin" for primary prevention of cardiovascular diseases despite evidence showing the risk of gastrointestinal bleeding often outweighs the benefits. We also see a trend toward lowering diagnostic thresholds.

If we applied certain international hypertension guidelines ($130/80$ mmHg) instead of the European standard ($140/90$ mmHg) in Spain, we would label five million more people as hypertensive. Treating an additional 1.4 million people pharmacologically would be unsustainable for any health system and leads to unnecessary medicalization.

Identifying the "Do-Not-Do" List

Q: What are the most common avoidable interventions in today's clinics?

CB: We need to be critical of:

• Routine ECGs in healthy, asymptomatic individuals.

• Indiscriminate screening for abdominal aortic aneurysms without clear risk factors.

• Over-the-counter supplements (Omega-3, calcium, or magnesium) to lower vascular risk when the evidence simply isn't there.

Looking Ahead to Madrid 2026

Q: The Forum is just one month away. Why is this a "must-attend" event for the WONCA community?

CB: It is a unique opportunity to network with top European experts—including figures like Iona Heath and Pilar Astier. We will be discussing highly relevant topics like overdiagnosis, overtreatment, sustainability, and equity in prevention. Beyond the science, our Gala Dinner will be at the historic Casa de la Panadería in Plaza Mayor. It’s about revitalizing our professional social fabric. And, of course, Madrid in the spring is lovely and sunny!

[Sidebar: 1 Month to Go! – Fast Facts]

• Global Expertise: Global Expertise: Global expertise: 20+ universities from Europe and beyond (Brazil, Qatar, Israel…)

• Accreditation: Application made to UEMS EACCME® for CME/CPD credits.

• Key Themes: Teaching prevention in medical curriculums and the role of the multidisciplinary team.

Click here to Register to the Forum