Amsterdam, The Netherlands –Tuesday 3 September 2013: EUROASPIRE IV has revealed the achievements and remaining challenges for secondary prevention in coronary patients across Europe. The latest results were presented at ESC Congress 2013 today.
The EUROASPIRE surveys are part of the ESC’s EORP programme1 and track lifestyle, risk factor control and cardioprotective drug use in Europe. Results from the 24 countries in the hospital arm of EUROASPIRE IV are presented for the first time at ESC Congress 2013. The primary care arm will be conducted next year.
Data were collected using standardised methods during May 2012 to April 2013 in 7,998 patients < 80 years with established coronary heart disease (25% women, mean age 64 years, one-third <60 years old). Patients had been hospitalised in the last years for coronary heart disease. They were interviewed and clinically examined for the study 6 months to 3 years (median 1.35 years) after the hospital episode.
The prevalence of obesity (BMI>30kg/m2) was 38% (36% of men, 44% of women). Obesity varied from between 25% and 30% in centres from Bosnia Herzegovina, the Netherlands, Serbia and Sweden to more than 45% in centres from Romania, the Russian Federation and Slovenia.
The prevalence of central obesity (waist circumference >88cm in women, >102cm in men) was 58% (53% in men, 75% in women). The range2 in women was 62-86%. Professor Guy De Backer (Belgium) said: “Obesity is more than double expected levels for this age group. We also found that 38% of obese patients had no plans for weight loss and 20% had never been told they had a weight problem.”
The prevalence of diabetes was 40%, comprised of 27% who knew they had diabetes and 13% undiagnosed but with a fasting plasma glucose >7.0 mmol/L during the study. Of those with known diabetes, 53% had HbA1c <7% meaning it was well controlled. Professor De Backer said: “In adults of that age we would expect a diabetes prevalence of 10-15% so our finding of 40% is extremely high. Among those diagnosed with diabetes,HbA1c was uncontrolled (>7%) in less than 35% of patients in centres from Belgium and Finland to more than 55% of patients in centres from Bulgaria, Croatia, France, Turkey and the UK.
Smoking (self reported or >10ppm CO in expired breath) was found in 16% of patients (18% of men, 11% of women, 34% of <50 year olds). Of the patients who were smokers before hospitalisation 51% were still smoking 1.3 years later. Professor De Backer said: “Smoking is still a major problem especially in younger patients.”
The prevalence of elevated blood pressure (>140/90mmHg) was 39% (range 24-56%), while 11% of patients had grade 2 hypertension (>160/100mmHg). Antihypertensive drugs were used in 78% of patients (range 52-94%), of whom 58% had well controlled blood pressure (<140/90mmHg).
Some 87% of patients were taking lipid lowering drugs (almost exclusively statins) (range 75-95%). Of these, 58% had a LDL-C level of < 2.5 mmol/L (100 mg/dL) but only 21% reached an LDL-C target of <1.8mmol/L (70mg/dL). Most patients (94%) took antiplatelet drugs and 83% took beta blockers.
Most patients (94%) said they were fully (74%) or nearly (20%) compliant with their drugs. Professor De Backer said: “These findings do not confirm claims by physicians that patients are not taking the medications they are prescribed.”
Only half (51%) of patients received advice to attend rehabilitation and prevention programmes (range 0-95%), and of these 72% fully attended. Professor De Backer said: “Some countries do not have any programmes on secondary prevention and rehabilitation while in others they are standard practice. Most patients follow advice to attend such programmes so the challenge is to achieve wider implementation across Europe in all countries.”
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