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. The second ASPIRE-2-PREVENT survey included people at high cardiovascular risk in general practice. The aim was to determine in high risk individuals whether the JBS2 and NICE guidance on cardiovascular disease prevention are being followed in clinical practice.
Methods ASPIRE-2-PREVENT survey was undertaken in 2008–2009 in 18 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales, and Scotland. Consecutive patients, men and women <80 years of age, without a history of coronary or other atherosclerotic disease, either started on antihypertensive and/or lipid lowering and/or anti-diabetes treatments, were identified retrospectively. Data collection was based on a review of patients medical notes and a prospective interview and examination by trained nurses using standardised methods and instruments at least 6 months after the start of medication.
Results A total of 943 high risk individuals were identified and 446 (47.5% females) were interviewed (participation rate 48.5%). Overall, 13.3% smoked cigarettes, 85.5% were overweight (BMI≥30 kg/m2), 50.2% obese (BMI≥30 kg/m2) and 76.4% centrally obese (waist circumference≥94 cm in men (≥90 cm in Asian men) or≥80 cm in women), 51.3% had blood pressure ≥ 140/85 mmHg (≥130/80 in people with diabetes mellitus), 78.7% had total cholesterol≥4.0 mmol/l, 43.8% reported a history of diabetes and 1.4% had newly diagnosed diabetes. Risk factor control was poor, with only 47.4% of those patients using antihypertensive medication at blood pressure goal (<140/85 mmHg, <130/80 mmHg in diabetes), 30.8% of patients on lipid-lowering medication at total cholesterol goal of <4.0 mmol/l and 31.0% of patients with diabetes at fasting plasma glucose goal ≤6.0 mmol/l. Cardioprotective medication: aspirin or other anti-platelets 28.4%; β-blockers 11.3%; ACE inhibitors/Angiotensin receptor blockers 54.6%; calcium channel blockers 26.4%; diuretics 25.4% and statins 61.2%.
Conclusions The ASPIRE-2-PREVENT survey shows the lifestyle of high risk patients is a major cause for concern with high prevalences of smoking, obesity and central obesity. Blood pressure, lipid and glucose control are inadequate with most patients not achieving the targets defined in the JBS2 prevention guidelines. Primary prevention needs a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by general practitioners, nurses and other allied health professionals.
- high cardiovascular risk people
- primary prevention
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