CVD has declined rapidly in almost all Western European countries, with a reduction of up to 30-50% in the last 10 years in some countries. The decline is observed in both men and women, and the majority can be attributed to improvements in primary and secondary prevention. However, not all risk factors show a beneficial trend. While smoking rates and population cholesterol levels have gone down, obesity and diabetes are increasing. This causes some concern as to whether the beneficial development in the recent decades will continue or not. Psychosocial stress, such as depression, anxiety and burn-out, which are now recognized as important contributors to CVD incidence and prognosis, are not declining. Also, disparities in CVD mortality, both east-west, socioeconomic and other disparities remain high.
Since 1995-1996, the cross-sectional EUROASPIRE (European Action on Secondary and Primary Prevention to Reduce Events) study has evaluated the European prevention effort in patients <80 years with coronary disease (i.e. coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome). In the most recent cohort, EUROASPIRE IV (2012-2013), 78 centres from 24 European countries were included, 16,426 medical records were reviewed and 7,998 patients were interviewed. The median time between index event and interview was 1.34 years .
EUROASPIRE documented that cardiovascular risk factors still go undiagnosed: 19% of the participants had newly diagnosed diabetes, while 35% had known diabetes . In 2004, the Euro Heart Survey on diabetes and the heart determined that in patients with acute CHD, 22% had newly diagnosed diabetes, 32% had known diabetes and 36% had impaired glucose regulation. In patients with stable CHD, the proportions were 14%, 30%, and 37%, respectively .
Risk factor control in secondary prevention remains suboptimal. Based on medical records, 77.8% of the participants in EUROASPIRE IV had hypertension and 72.8% had dyslipidaemia. At the time of the interview, 42.7% had a blood pressure ≥ 140/90 and only 19.5% had LDL cholesterol ≤ 1.8 mmol/L . Further, 82.1% were overweight (BMI>25 kg/m2), and 37.6% were obese (BMI > 30 kg/m2). Central obesity (waist circumference ≥102 cm in men or ≥88 cm in women) was observed in 58.2% of the participants. These numbers have increased compared to the prior EUROASPIRE cohorts I-III. While the majority reported increased physical activity after the event, only 40.1% reported vigorous physical activity for at least 20 minutes once a week or more. Thirty percent were smokers and only half had stopped smoking at the time of the interview. Most smokers had received advice to stop smoking. Of the 50.7% advised to participate in a cardiac rehabilitation programme, 81.3% attended at least half the sessions .
Thus, while preventive cardiology has been a great success as shown by the decline in CVD mortality, there is still ample room for improvement. Registry studies have found that 18% of patients who suffered a myocardial infarction, suffer recurrent events within the first year . It has been estimated that this could be more than halved if secondary prevention measures were more rigorously implemented.
In a concerted effort to implement secondary prevention measures, many countries and organisations have developed information websites. The following links may prove useful for CVD Prevention in individual countries.
EAPC Prevention in your Country
Country reports provided by National CVD Prevention Coordinators in ESC Member Countries.