Introduction EUROASPIRE surveys, conducted by the European Society of Cardiology in 1995-96 (9 countries), 1999-2000 (15 countries) and 2006-2007 (22 countries) showed a high prevalence of modifiable risk factors in patients with coronary heart disease (CHD) in Europe and a real potential to further reduce morbidity and mortality. The aim of the EUROASPIRE IV survey was to determine in patients with CHD whether the Joint European Societies’ guidelines on cardiovascular disease (CVD) prevention are being followed in clinical practice.
Methods EUROASPIRE IV survey was undertaken in 74 centres in 24 European countries. Consecutive patients, men and women <80 years of age at the time of the index event or procedure, and with one or more of the following diagnoses: coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction and acute myocardial ischaemia, were identified retrospectively. Data collection was based on a review of hospital medical records and a prospective interview and examination at least six months after index event or procedure.
Results A total of 16,426 medical records (24.4% females) were reviewed and 7,998 patients were interviewed on average 1.4 years following their index event. At interview, 16.0% of patients smoked cigarettes, 37.6% were obese (BMI ≥ 30 kg/m2), 52.7% had central obesity (waist circumference ≥ 102 cm in men or ≥ 88 cm in women), 58.2% had raised blood pressure (BP ≥ 140/90 mmHg; ≥ 140/80 mmHg for patients with diabetes), 80.5%% had LDL cholesterol ≥ 1.8 mmol/l and 26.8% had self-reported diabetes. The use of prophylactic drug therapies was as follows: aspirin or other anti-platelets drugs 93.8%, beta-blockers 82.6%, ACE inhibitors/ARBs 75.1%, and statins 85.7%. Only 53.3% of patients using blood pressure lowering medication were controlled (BP < 140/90 mmHg; < 140/80 mmHg for patients with diabetes) and 21.1% of patients on lipid-lowering medication had achieved the LDL cholesterol goal of < 1.8 mmol/l. The therapeutic control of diabetes was unsatisfactory, with only 52.5% of patients with self-reported diabetes having HbA1c < 7.0 mmol/l.
Conclusions EUROASPIRE IV shows that a large majority of coronary patients have adverse lifestyles and many do not achieve the blood pressure, lipid and diabetes targets. A wide gap continues to exist in the implementation of evidence-based medicine in cardiological practice in both hospital and primary care. There is a considerable potential to raise the standard of preventive care in Europe through preventive cardiology programmes involving multidisciplinary teams of health-care professionals helping patients to achieve the lifestyle, risk factors and therapeutic targets for CVD prevention.
- risk factor management
- coronary disease
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