Kornelia Kotseva: ‘All coronary patients should be professionally encouraged to lose weight.’
A report on these surveys of lifestyle, risk factor control and drug management in coronary patients was presented in a Registry Hot Line session yesterday by Dr Kornelia Kotseva, chair of the EUROASPIRE steering committee, and showed unequivocally that, while blood pressure and cholesterol control are improving, the prevalence of obesity and diabetes continues to rise alarmingly in this high risk group of patients.
The analysis from the EUROASPIRE surveys - which were conducted on behalf of the ESC EURObservational Research Programme of surveys and registries - included a total of 12,775 consecutive patients <70 years with coronary artery disease initially surveyed in studies II (1999-2000), III (2006-2007) and IV (2012-2013), of whom 8456 were interviewed at least six months after their initial hospitalisation. The interviews were performed in Belgium, Czech Republic, Finland, France, Ireland, the Netherlands, Poland, Slovenia, and UK.
Although the overall smoking prevalence remained level over the three surveys (21% in 1999/2000, 19.9% in 2006/7, 18.2% in 2012/13; p=0.55), it was still highest in patients under 50 years.
However, if smoking has remained a steady problem in secondary prevention, the prevalence of obesity and diabetes is now on a steeply rising trend, increasing throughout the three surveys from 31.9 to 38.5% (p=0.007) and from 18.5% to 27.2% (p=0.0004) respectively. Average BMI increased from 28.5 to 29.2 kg/m², and the prevalence of central obesity from 51% to 57%, while physical activity did not change over the 14 year study period.
However, the prevalence of raised blood pressure dropped by 8% from survey III to IV, while the prevalence of very high blood pressure (systolic BP ≥160 mmHg and/or diastolic ≥100 mmHg) dropped significantly across the three surveys (21.9%, 16.8% and 12.8%; p=0.0006). Therapeutic control of blood pressure in patients using drugs improved, with 55% of patients below target in survey III. Similarly, the prevalence of raised total (≥4.5 mmol/l) and LDL cholesterol (≥2.5 mmol/l) declined significantly over the three surveys, the former from 77 to 33% and the latter from 78 to 33%.
Kotseva told Congress News: ‘We are seeing an improvement in the management of high blood pressure and cholesterol but there are still many coronary patients who are not achieving their targets, and any overall benefits gained are mitigated by poor lifestyle and a growth in obesity and diabetes.’
Detailed results from EUROASPIRE IV, which was performed in 7988 coronary patients <80 years in 24 countries, were presented at a symposium on Sunday and showed just how common obesity now is among coronary patients, with prevalence recorded at around 38%, the highest level ever and accounting for 36% of the men and 44% of the survey.
As a result, the prevalence of diabetes was found to be 40% (including 13% undiagnosed but with a fasting plasma glucose >7.0 mmol/L). Of those with known diabetes, 53% had HbA1c <7% suggesting the disease was well controlled. ‘Prevention programmes directed at lifestyle and diabetes management will be necessary to reverse this trend,’ said Kotseva. A 40% prevalence, she noted, is much higher than might be expected in this age range in the general population.
The prevalence of elevated blood pressure (>140/90mmHg) was 39%, including 11% with grade 2 hypertension (>160/100mmHg). Antihypertensive drugs were used in 78% of patients, of whom 58% had well controlled blood pressure (<140/90mmHg). Some 87% of patients were taking lipid lowering drugs (almost exclusively statins).
Kotseva, from the National Heart & Lung Institute in London, described the prevalence of obesity in European coronary patients as ‘alarming’, noting that fewer than one in five were within target BMI. ‘All coronary patients should be professionally encouraged to lose weight,’ she said. ‘Adverse lifestyle trends in our coronary patients now represent the biggest challenge for those leading prevention and rehabilitation programmes. The results show that, despite the existence of clear, evidence-based guidelines, their integration into routine clinical care is still disappointing, and there is still much room to raise the standards of preventive cardiology throughout Europe.’
Professors Joep Perk and Christi Deaton discuss the EUROASPIRE presentation at the ESC TV Studio. Watch the interview here.