The EUROASPIRE survey, conducted on behalf of the European Society of Cardiology (ESC), analysed medical records and interviewed almost 9,000 patients with coronary heart disease in 22 countries of Europe. EUROASPIRE III is the third survey of the series and was carried out in 2006-2007 in patients from 76 coronary care centres in Europe. Consecutive patients with a diagnosis of coronary heart disease were identified and interviewed and examined at least six months after their coronary event.
Results reported in Prague from the interviews show that
- 56% had blood pressure levels above target (140/90 mmHg, 130/80 mmHg for patients with diabetes)
- 51% had serum cholesterol levels above target (4.5 mmol/l)
- 35% had diabetes (defined as self-reported or fasting plasma glucose ≥7 mmol/L)
Lifestyle, risk factor and therapeutic targets for the prevention of cardiovascular disease are clearly set out in the Joint European Societies Guidelines, and give the highest priority to those with coronary disease - what is known as "secondary prevention".(2) Among the goals of these Clinical Practice Guidelines are to maintain a maximum body mass index of 25 kg/m2, blood pressure no higher than 140/90 mmHg (130/80 in diabetics) and total cholesterol no higher than 4.5 mmol/l.
However, Dr Kotseva and her colleagues report that only 44% of patients using medication to lower blood pressure were adequately controlled (a blood pressure of 140/90 mmHg or less, <130/80 mmHg for patients with diabetes) and only 55% of patients on lipid-lowering medication achieved the total cholesterol goal of <4.5 mmol/l.
Dr Kotseva described the therapeutic control of diabetes as "very poor", with only 10% of self-reported diabetics having fasting glucose levels of 6.1 mmol/L or less.
The most widely used cardio-protective medications were aspirin (or other anti-platelet drugs), used by 90% of patients, beta-blockers (80%), ACE inhibitors/angiotensin II receptor blocker (71%), and lipid-lowering drugs (80%). However, despite an increase in the use of these preventative drug treatments, Dr Kotseva reported that the majority of patients are still not achieving blood pressure and cholesterol targets.
"Our results clearly demonstrate a challenging gap between what is recommended in the Guidelines and what is achieved in daily clinical practice," said Dr Kotseva. "They also clearly show that simply prescribing more and more cardioprotective drugs is not sufficient to meet targets. Drug treatments must be combined with professional lifestyle intervention. All coronary patients need a professional cardiovascular prevention and rehabilitation programme which addresses all aspects of lifestyle and the effective control of all other risk factors - as well as appropriate use of cardio-protective drug therapies.
"Secondary and primary prevention need a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by cardiologists, GPs, nurses and other health professionals.