EMBARGO : 1 September 2015 at 11:00 BST
EUROASPIRE is a series of cross sectional surveys of the practice of preventive cardiology in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) across Europe. Four EUROASPIRE surveys have been conducted under the ESC’s EORP initiative.2 EUROASPIRE III, conducted in 2006 to 2008, included for the first time people at high risk of developing CVD in general practice from 12 countries. The primary care arm of EUROASPIRE IV was carried out in 2014 to 2015 in 14 countries.
The current study was a time trend analysis of lifestyle, risk factor and therapeutic management in people at high risk of developing cardiovascular disease between the EUROASPIRE III and IV surveys in general practice. It was conducted in the five countries (Bulgaria, Croatia, Poland, Romania and the UK) that participated in both surveys. A total of 5 890 consecutive patients were included of whom 3 827 were interviewed across the two surveys.
“We wanted to see whether there had been any change in lifestyles or risk factors between the two surveys and whether the practice of preventive cardiology in patients at high risk of developing CVD had improved over time,” said Professor Kotseva.
In each general practice, consecutive patients under the age of 80 years, with no history of coronary or other atherosclerotic disease, who had been prescribed one or more of the following medications: (i) anti-hypertensive and/or (ii) lipid lowering and/or (iii) anti-diabetes treatments (diet and/or oral hypoglycaemics and/or insulin) were retrospectively identified and invited to an interview and examination. Study interviews took place ≥6 months and ≤3 years after the recruitment interview. The primary endpoints were the proportions of patients achieving targets for CVD prevention in the 2012 European societies’ guidelines.3
The analysis shows that smoking prevalence stayed the same (17% in both surveys; p=0.90) and remained highest in patients <50 years. The proportion of smokers with no intention of quitting increased from 23% to 34% (p=0.004). Professor Kotseva said: “The highest levels of smoking are still in the youngest patients who have the most to gain from quitting. But the use of pharmacotherapy for smoking cessation remained very low over the seven years so more emphasis is needed in this area.”
There was no change across the two surveys in the prevalence of overweight (82% and 82%; p=0.85), obesity (44% and 43%; p=0.88) or central obesity (59% and 62%; p=0.05), or in levels of physical activity. Less than one in five patients in both surveys reported having vigorous physical activity outside work for ≥ 20 minutes at least three times a week (16% and 19%; p=0.68).
Therapeutic control of blood pressure in patients using blood pressure lowering medication slightly improved but not significantly (28% and 35%; p=0.12), with 65% of patients above the recommended target (systolic <140 mmHg and/or diastolic <90 mmHg; <140/80 mmHg in patients with diabetes) in EUROASPIRE IV.
The proportion of patients on lipid-lowering medication who met the LDL cholesterol target (<2.5 mmol/L) increased insignificantly from 29% to 37% (p=0.38). However, 63% of patients still did not reach the target. Glycaemic control in patients with diabetes remained unchanged (62% and 60%; p=0.75), with 40% of patients not achieving the target of HbA1c <7% in EUROASPIRE IV.
“Lifestyle trends are not moving in the right direction,” said Professor Kotseva. “The prevalence of smoking, obesity and central obesity has not changed over the two surveys with more than four in five people at high risk of developing cardiovascular disease being overweight or obese. The therapeutic control of blood pressure and lipids has not improved significantly and the vast majority of patients do not reach the targets defined in the guidelines.”
She concluded “Our analysis highlights the pressing need for modern preventive cardiology programmes integrating lifestyle and medical risk factor management, adapted to the medical and cultural settings in each country. Health care systems that invest in prevention are urgently needed.”