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‘We need to invest in prevention’: Latest EUROASPIRE data on managing cardiovascular risk in primary care

ESC Congress News 2015 - London

THE EUROASPIRE surveys, which began their first collections of data in 1995-96, are now part of the ESC’s EURObservational Research Programme, or EORP. The programme has grown from just two pilot surveys (both in heart failure) to a broad-ranging and far-reaching programme of 12 registries arranged within the categories of ‘General’, ‘Sentinel’, ‘Special’ and ‘Prevention’, the last of which now includes both arms, hospital and primary care, of the EUROASPIRE data collection.

Cardiovascular Disease in Primary Care
Risk Factors, Prevention, Rehabilitation, Sports Cardiology

Kornelia Kotseva, Chair of the EUROASPIRE Steering Committee, described as ‘disappointing’ the implementation of prevention guidelines into everyday clinical practice.The latest results from the secondary prevention hospital arm of EUROASPIRE IV were published in February and showed yet again that the large majority of coronary patients in Europe are failing to achieve their lifestyle, risk factor and therapeutic targets as set out in the latest prevention guidelines. This, from the very start of the EORP programme, was one of its fundamental aims - to monitor adherence to guidelines.

And later today EUROASPIRE investigators will present their latest findings on how we are managing cardiovascular risk factors in primary care. ‘Adherence to guidelines is still poor,’ says Chair of the EUROASPIRE Steering Committee Kornelia Kotseva from the National Heart and Lung Institute at Imperial College London. ‘We clearly need to find better ways to manage and control risk factors.’

EUROASPIRE III, published in 2010, interviewed more than 4300 individuals considered at high risk of CVD but without any obvious coronary or atherosclerotic disease. The interviews, performed in 66 general practices in 12 countries, indicated that 16.9% smoked cigarettes, 43.5% had a BMI ≥30 kg/m2, 70.8% had blood pressure ≥140/90 mmHg (≥130/80 in people with diabetes mellitus), 66.4% had total cholesterol ≥5.0 mmol/l (≥4.5 mmol/l in people with diabetes) and 30.2% reported a history of diabetes. Risk factor control was described as ‘very poor’, and the lifestyle of those interviewed - representing a broad population of high risk individuals - as ‘a major cause of concern with persistent smoking and high prevalence of both obesity and central obesity’.

It is the management of these lifestyle factors which the investigators now define as the ‘new challenges’ of this morning’s Symposium. ‘We need a more comprehensive and integrated approach to lifestyle management,’ says Kotseva, ‘because what we’re doing now is clearly not working.

The primary care arm of the latest EUROASPIRE survey was carried out in 2014-2015 in 14 countries (Bosnia & Herzegovina, Bulgaria, Croatia, Kazakhstan, Lithuania, Poland, Portugal, Romania, Russian Federation, Serbia, Spain, Sweden, Ukraine, UK), which included six countries from EUROASPIRE III. Again, the aim was to determine adherence to European guidelines and if preventive cardiology practice in high-risk patients has improved over time.

In each participating general practice, consecutive patients under 80 years without a history of coronary or other atherosclerotic disease were identified by anti-hypertensive and/or lipid lowering and/or anti-diabetes treatments and invited for interview and examination. Primary outcomes are the proportions of patients achieving the lifestyle, blood pressure, lipid and diabetes targets as defined in the 2012 guidelines for CVD prevention. Results will be presented for the first time in this morning’s Symposium, while the time trends (from EUROASPIRE III and IV), will be presented on Tuesday in the ‘Registry III – Prevention’ session.

Following their EUROASPIRE IV report in February on coronary patients in Europe the investigators called for ‘a new approach to cardiovascular prevention...which integrates cardiac rehabilitation and secondary prevention into modern preventive cardiology programmes’. Such recommendations, it now seems, will be just as relevant in primary care as in cardiac rehabilitation. ‘Despite the existence of clear, evidence-based guidelines,’ says Kotseva, ‘their implementation into everyday practice is still disappointing. We need to invest in prevention.’

How are we managing cardiovascular risk in the primary care environment? EUROASPIRE IV survey, 30 Aug 11:00-12.30  Bratislava - Village 2

Clinical reality of primary prevention in people at high cardiovascular risk in Europe: a comparison of EUROASPIRE III and IV surveys in general practice, 1 Sep 11.15-11.30 Hyde Park - The Hub