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115 ASPIRE-2-PREVENT: a British cardiovascular society survey on the lifestyle and risk factor management and use of cardioprotective medication in coronary patients in the UK
  1. K Kotseva1,
  2. C Jennings1,
  3. E Turner2,
  4. D Wood1
  1. 1Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK


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

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