Prof. Lars Ryden,
Dr. David Allan Wood,
Presenter report:Wood, David AwebcastThree EUROASPIRE surveys in patients with CHD have been carried out under the auspices of European Society of Cardiology Euro Heart Survey programme in 1995/1996, 1999/2000 and 2006/2007.The EUROASPIRE III survey has been extended beyond coronary patients to include people at high cardiovascular risk in general practice in 12 European countries: Belgium, Bulgaria, Croatia, Finland, Germany, Italy, Latvia, Poland, Romania, Slovenia, Spain and the UK. 4366 high risk individuals, either started on antihypertensive and/or lipid lowering and/or anti-diabetes treatments, have been interviewed and examined at least 6 months after the start of medication. Overall, 16% smoked cigarettes, 43% were obese and 62% centrally obese, 71% had blood pressure ≥ 140/90 mm Hg (≥ 130/80 in people with diabetes mellitus), 79% had total cholesterol ≥ 4.5 mmol/l and 39% reported a history of diabetes, of whom 53% had a HbA1c < 6.5%. The use of cardioprotective medication was: aspirin or other anti-platelets 22%; beta-blockers 31%; ACE inhibitors/ ARB 56%; calcium channel blockers 24%, and statins 40%.The EUROASPIRE III survey shows that the lifestyle of high risk patients is a major cause for concern with persistent smoking and high prevalences of both obesity and central obesity. Blood pressure, lipid and glucose control are completely inadequate with most patients not achieving the targets defined in the prevention guidelines. Primary prevention needs a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by GPs, nurses and other health professionals, a health insurance system dedicated to prevention and all of this complemented by a population strategy for the community at large.
Discussant report:Ryden, Lars webcastThis trial is important but the results are indeed a disappointment. Treatment targets for the management of high risk individuals are clearly outlined in European guidelines, widely distributed across Europe, but obviously not adhered to in a sensible way.
An important question is whether the results of EUROASPIRE III are generally applicable. The study has considerable strengths: representation of many European countries, a large patient cohort (about 5,700 records; 4,300 interviews), a reasonable time between drug initiation and study providing time for treatment refinement. Concerns are the likelihood of a positive centre selection with over-representation of particularly devoted physicians. But, if anything such selection bias would create better results and it may be assumed that practice may be even worse. Another matter is the accuracy of medical records. The authors do, however, claim that quality control revealed data to be trustworthy.
It is Important to note that a majority of those interviewed wanted information on their risk and very few were negative. The self estimated risk, considered low or modest among 2/3 indicates that information was limited and alarmingly few (18%) received lifestyle information
This high risk population, not yet afflicted with cardiovascular events, should indeed be very important to manage with great skill and caution. This discussant completely agrees with the investigator’s conclusion that “a vast majority of high risk patients are not provided with the professional lifestyle and risk factor management program”.
Clinical Trial Update III
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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