Introduction The first ASPIRE survey, conducted by the British Cardiovascular Society in 1994–1995 showed a high prevalence of modifiable risk factors in coronary patients in the UK and a real potential to further reduce coronary heart disease morbidity and mortality. The aim of the ASPIRE-2-PREVENT survey was to determine in patients with established coronary disease whether JBS2 and NICE guidance on cardiovascular disease prevention are being followed in everyday clinical practice.
Methods ASPIRE-2-PREVENT survey was undertaken in 2008–2009 in 18 randomly selected hospitals in 12 geographical regions in England, Northern Ireland, Wales, and Scotland. 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 transluminal coronary angioplasty, acute myocardial infarction, acute myocardial ischaemia and exertional angina, were identified retrospectively. Data collection was based on a review of hospital medical records and a prospective interview and examination at least 6 months after index event or procedure.
Results A total of 1522 medical records (26.1% women) were reviewed and 676 patients were interviewed on average 13.0 (10.3, 16.2) months following their index event (participation rate 47.2%). At interview, 14.1% of patients smoked cigarettes and 47.1% were persistent smokers, 78.4% were overweight (BMI≥25 kg/m2), 38.0% obese (BMI≥30 kg/m2), 76.4% had central obesity (waist circumference ≥ 94 cm in men (≥90 cm in Asian men) or ≥ 80 cm in women), 46.9% raised blood pressure (BP≥130/80 mmHg), 52.6% elevated total cholesterol ≥ 4 mmol/l, 17.8% self-reported diabetes and 4.4% newly diagnosed diabetes (fasting plasma glucose≥7 mmol/l). Cardioprotective drug therapies: aspirin or other anti-platelets drugs 95.4%, β-blockers 74.8%, ACE inhibitors/ARBs 78.9%, statins 92.8%, anticoagulants 3.9%. 53.2% of patients on blood pressure lowering medication were controlled (BP<130/80 mmHg) and 48.3% patients on lipid-lowering medication had total cholesterol < 4.0 mmol/l. 29.6% of patients with self-reported diabetes had a fasting glucose ≤ 6.0 mmol/l.
Conclusions ASPIRE-2-PREVENT shows the lifestyle of coronary patients continues to be a major challenge with high prevalences of persistent smoking, obesity and central obesity and many patients not achieving the blood pressure, lipid and diabetes targets. So, a gap continues to exist in the implementation of evidence-based preventive medicine in cardiological practice. Prevention and rehabilitation of coronary, and other patients with atherosclerotic vascular disease, needs a systematic, comprehensive, multidisciplinary approach, which addresses all aspects of lifestyle, risk factor and therapeutic management.
- coronary patients
- secondary prevention