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

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

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

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

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

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

Prevalence of Obesity* * Body mass index ≥ 30 kg/m² S2 vs. S1 : P=0.009 S3 vs. S2 : P=0.051 S3 vs. S1 : P=0.0002 P=0.0006

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

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

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

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

Prevalence of Raised Total Cholesterol* * Total cholesterol ≥ 4.5 mmol/L P<0.0001 S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001

Prevalence of Raised LDL Cholesterol* LDL C ≥ 2.5 mmol/L for patients fasting for at least 6 hours P<0.0001 S2 vs. S1 : P=0.001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001

Therapeutic Control of Total Cholesterol* * Total cholesterol < 4.5 mmol/L S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

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

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

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

Medication Use: Antiplatelets S2 vs. S1 : P=0.29 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

Medication Use: Beta-Blockers S2 vs. S1 : P=0.001 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

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

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

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

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

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)

78% above the therapeutic target of < 7.0 mmol/l 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/ARB’s, statins and diuretics with a lower use of CCB’s.

‘A handful of pills is not enough’ Conclusions ‘A handful of pills is not enough’

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

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

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

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

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

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

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

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

EUROACTION and EUROASPIRE III

Conclusions Annie Holden Jennifer Jones j.jones@imperial.ac.uk annie.holden@bromleymytime.org.uk Jennifer Jones j.jones@imperial.ac.uk

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)

Coordination Coordinating Centre Data Management Statistical 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

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