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An unmet clinical need for Prevention in Europe

Comment by Paul Dendale, EACPR Cardiac Rehabilitation Section

Cardiovascular risk profile of patients included in stent trials; a pooled analysis of individual patient data from randomized clinical trials: insights from 33 prospective stent trials in Europe.
Vranckx P, Boersma E, Garg S, Valgimigli M, Van Es GA, Goedhart D, Serruys PW
EuroIntervention. 2011 Nov 15;7(7):859-71. doi: 10.4244/EIJV7I7A134


This paper published in a high level interventional journal focuses on the evolution of coronary risk factors over time. By analysing more than 10.000 patients enrolled in coronary stent trials in three time periods (1995-97, 1998-2002 and 2003-2206), the evolution of risk factors could be studied.
As expected, diabetes type II increased significantly from 16 to 25% over this time period, but overweight did not show a significant trend (69-70%). The proportion of smokers and patients with hypertension remained constant at approximately 25 and 50% respectively, but cholesterol levels decreased (probably due to statin treatment).

The authors conclude rightly that there is an unmet clinical need for prevention in Europe, and that the act of performing a PCI should “open the door towards optimising secondary prevention”.
This is as well a call for more cardiac rehabilitation after PCI : most studies show that inclusion in CR is low after PCI, even though the results are as good as after surgery.

Now, it remains only to convince our interventional colleagues: this paper may help in this regard.