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Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III Professor David A Wood on behalf of the EUROASPIRE Investigators.

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Presentation on theme: "Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III Professor David A Wood on behalf of the EUROASPIRE Investigators."— Presentation transcript:

1 Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III Professor David A Wood on behalf of the EUROASPIRE Investigators

2

3 Finland Czech Republic France Germany Hungary Italy Netherlands Slovenia EUROASPIRE I, II and III

4 Participation rates Survey I : 77.2% Survey II : 76.5% Survey III : 68.4%

5 Distribution of Age, Gender and Diagnostic Category (%) (years) GenderAgeDiagnostic category

6 Prevalence of Smoking* P=0.64 S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.37 S3 vs. S1 : P=0.48 * Self-reported smoking or CO in breath > 10 ppm

7 Prevalence of Overweight* P=0.04 S2 vs. S1 : P=0.15 S3 vs. S2 : P=0.22 S3 vs. S1 : P=0.02 * Body mass index 25 kg/m²

8 Prevalence of Obesity* P= S2 vs. S1 : P=0.009 S3 vs. S2 : P=0.051 S3 vs. S1 : P= * Body mass index 30 kg/m²

9 Prevalence of Central Obesity* * Waist circumference 102 cm in men or 88 cm in women P< S2 vs. S1 : P= S3 vs. S2 : P=0.47 S3 vs. S1 : P<0.0001

10 Prevalence of Raised Blood Pressure (1)* P=0.79 S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.51 S3 vs. S1 : P=0.65 * SBP 140 mmHg and/or DBP 90 mmHg

11 Prevalence of Raised Blood Pressure (2)* P=0.49 S2 vs. S1 : P=0.99 S3 vs. S2 : P=0.30 S3 vs. S1 : P=0.30 * SBP/DBP 140/90 mmHg for non-diabetics or 130/80 mmHg diabetics

12 Therapeutic Control of Blood Pressure* P=0.57 S2 vs. S1 : P=0.98 S3 vs. S2 : P=0.36 S3 vs. S1 : P=0.37 * SBP/DBP < 140/90 mmHg for non-diabetics or < 130/80 mmHg for diabetics

13 Prevalence of Raised Total Cholesterol* P< S2 vs. S1 : P< S3 vs. S2 : P< S3 vs. S1 : P< * Total cholesterol 4.5 mmol/L

14 Prevalence of Raised LDL Cholesterol* P< S2 vs. S1 : P=0.001 S3 vs. S2 : P< S3 vs. S1 : P< LDL C 2.5 mmol/L for patients fasting for at least 6 hours

15 Therapeutic Control of Total Cholesterol* P< S2 vs. S1 : P< S3 vs. S2 : P< S3 vs. S1 : P< * Total cholesterol < 4.5 mmol/L

16 Prevalence of Diabetes* P=0.004 S2 vs. S1 : P=0.21 S3 vs. S2 : P=0.02 S3 vs. S1 : P=0.001 * Self-reported history of diagnosed diabetes

17 Prevalence of Undiagnosed Diabetes* P=0.005 S2 vs. S1 : P=0.002 S3 vs. S2 : P=0.62 S3 vs. S1 : P=0.006 * Glucose 7 mmol/L for patients fasting for at least 6 hours

18 Therapeutic Control of Diabetes* P=0.04 S2 vs. S1 : P=0.82 S3 vs. S2 : P=0.03 S3 vs. S1 : P=0.08 * Fasting glucose < 7 mmol/L in patients with history of diabetes

19 Medication Use: Antiplatelets P<0.0001S2 vs. S1 : P=0.29 S3 vs. S2 : P= S3 vs. S1 : P<0.0001

20 Medication Use: Beta-Blockers P<0.0001S2 vs. S1 : P=0.001 S3 vs. S2 : P= S3 vs. S1 : P<0.0001

21 Medication Use: ACE Inhibitors & Angiotensin II RA P< S2 vs. S1 : P< S3 vs. S2 : P< S3 vs. S1 : P<0.0001

22 Medication Use: Statins P< S2 vs. S1 : P< S3 vs. S2 : P< S3 vs. S1 : P<0.0001

23 Medication Use: Diuretics P=0.006 S2 vs. S1 : P=0.30 S3 vs. S2 : P=0.02 S3 vs. S1 : P=0.002

24 Conclusions from the EUROASPIRE surveys Lifestyle of coronary patients is a major cause for concern with no change in prevalence of smoking and continuing adverse trends in prevalence of obesity and central obesity

25 Conclusions No change in blood pressure control despite increased use of anti-hypertensive medications 61% above therapeutic target (BP < 140/90 mmHg) Continuing improvement in lipid control with increased use of statins 42% above the 2003 therapeutic target (TC < 4.5 mmol/l)

26 Conclusions Increasing prevalence of diabetes, both self reported and undetected, and deteriorating therapeutic control 78% above the therapeutic target of < 7.0 mmol/l Increased use of anti-platelets, beta- blockers, ACE/ARBs, statins and diuretics with a lower use of CCBs.

27 Conclusions A handful of pills is not enough

28 Cardiac Rehabilitation Standards and Core Components for Cardiac Rehabilitation 2007 Lifestyle Education Risk factor management Psychosocial Cardio-protective drug therapy Long term management strategy

29 Cardiac Rehabilitation Standards and Core Components for Cardiac Rehabilitation 2007 Core team Cardiac specialist nurse Physiotherapist Dietician Administrator Designated clinical lead

30 EuroASPIRE III Interview All patients: 44.9% MOR = 5.46 Men 45.9%, Women 42.0% Advise to follow cardiac rehabilitation programme* * Within 3 months of discharge following the index event or procedure

31 EuroASPIRE III Interview All patients: 33.9% MOR = 7.07 Men 34.9%, Women 31.0% Attendance at CR programme among all patients* * Attending at least half of the sessionsNote: CPR attendance rate if advised to follow = 75.8%

32 8 countries, 24 centres, 10,000+ subjects EUROACTION

33 Nurse coordinated multidisciplinary family based approach The CVP&R team with Dr Martini in Boldrini Hospital, Thiene, Italy The CVP nurse with Dr Van Nunen in Hoensbroek, The Netherlands

34 EUROACTION and EUROASPIRE III * WC < 94 cm (men); < 84 cm (women) **SBP/DBP 140/90 mmHg for non-diabetics or 130/80 mmHg for diabetics ****Self-reported and/or glucose 7.0 mmol/l; **** in patients with diabetes

35 EUROACTION and EUROASPIRE III * WC < 94 cm (men); < 84 cm (women) **SBP/DBP 140/90 mmHg for non-diabetics or 130/80 mmHg for diabetics ****Self-reported and/or glucose 7.0 mmol/l; **** in patients with diabetes

36 EUROACTION and EUROASPIRE III

37 Conclusions Annie Holden Jennifer Jones

38 Management Committee Professor Ulrich Keil (Chairman) Professor Philippe Amouyel Professor Guy de Backer Professor Dirk De Bacquer Professor Alain Cohen-Solal Professor Dan Gaita Ms Catriona Jennings Dr Kornelia Kotseva Ms Malika Manini Dr Keith McGregor Professor Andrzej Pajak Professor Zeljko Reiner Professor David Wood (Principal Investigator)

39 Coordination Coordinating Centre Department of Cardiovascular Medicine Imperial College London UK Data Management Euro Heart Survey Team Sophia Antipolis, France Statistical Centre Department of Public Health University of Ghent Laboratory Centre National Public Health Institute, Helsinki, Finland

40 Sponsors Unrestricted educational grants to the European Society of Cardiology AstraZeneca Bristol-Myers Squibb GlaxoSmithKline Pfizer Sanofi-Aventis Servier Merck /Schering-Plough Novartis


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