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EUR Observational Research Programme

EUR Observational Research Programme. Clinical reality of primary prevention in people at high cardiovascular risk in Europe A comparison of EUROASPIRE III and IV surveys in general practice Kornelia Kotseva National Heart and Lung Institute, Imperial College London, UK

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EUR Observational Research Programme

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  1. EURObservationalResearch Programme Clinical reality of primary prevention in people at high cardiovascular risk in Europe A comparison of EUROASPIRE III and IV surveys in general practice Kornelia Kotseva National Heart and Lung Institute, Imperial College London, UK onbehalfofEUROASPIRE IV Investigators

  2. Grant/Research Support European Society of Cardiology Disclosure Statement of Financial Interest Within the past 12 months, I have had a financial interest/arrangement or affiliation with the healthcare related company listed below.

  3. 1994FirstJoint Task Force Recommendations • 1994 Joint European Societies Implementation Group on Coronary Prevention • 1995–96EUROASPIRE I • 1998Second Joint Task Force Recommendations • 1999–2000 EUROASPIRE II • 2000 Joint European Societies CVD Prevention Committee • Third Joint Task Force Guidelines • Joint European Societies CVD Prevention Committee • 2006–2007EUROASPIRE III • 2007 Fourth Joint Task Force Guidelines • Fifth Joint Task Force Guidelines • –15 EUROASPIRE IV – European survey of CVD • prevention and diabetes European recommendations and surveys on cardiovascular disease prevention

  4. The EUROASPIRE surveys identifiesrisk factors in high risk individuals describes theirmanagementthrough lifestyle and use of drug therapies providing objective assessment of clinical implementationof current knowledge EUROASPIRE Surveys

  5. To describe 8-year time trends in lifestyle and risk factor management use of cardioprotective drug therapies In people at high cardiovascular risk Between the EUROASPIRE III and IV surveys in general practice Objective

  6. Methods • Consecutive patients, men and women <80 years • No history of coronary or other atherosclerotic disease • Prescribed one or more of the following medications ≥6months and ≤3 years prior to the interview 1. Blood pressure lowering and/or 2. Lipid lowering and/or 3. Glucose lowering (diet, oral drugs and/or insulin) • Interview and examination ≥6 months later

  7. Data Collection • Height, weight • Waist circumference • Blood pressure • Breath CO • Fasting venous bloodsample for serum total cholesterol, HDL-cholesterol, triglycerides, glucose and HbA1c

  8. Outcome Measures Proportions of high CVD risk individuals achieving the European lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention defined in the Joint European Societies Guidelines on CVD prevention

  9. Study Population EUROASPIRE III & IV Countries Bulgaria, Croatia, Poland, Romania, UK

  10. Prevalence of smoking* at interview(%) * Self-reported smoking or CO in breath > 10 ppm

  11. No intention to quit smoking*(%) * Among current smokers

  12. Prevalence of overweight* (%) * Body mass index ≥25 kg/m2

  13. Prevalence of obesity*(%) * Body mass index ≥30 kg/m2

  14. Prevalence of central obesity*(%) * Waist circumference ≥88/102 cm women/men

  15. Obese patients ever been told by a health care professional that their diet is unhealthy (%) * Body mass index ≥30 kg/m2

  16. Obese patients ever been told by a health care professional that they are overweight (%) * Body mass index ≥30 kg/m2

  17. Obese patients actively trying to lose weightin the last month(%) * Body mass index ≥30 kg/m2

  18. Obese patients considering trying to lose weight in the next month(%) * Body mass index ≥30 kg/m2

  19. Vigorous physical activity outside work for ≥ 20 min at least three times a week (%)

  20. Proportion of patients not doing regular exercise* to increase physical fitness (%) * Regular exercise is any planned physical performed to increase physical fitness. The activity should be performed 3-5 times/week for 20-60 minutes/session.

  21. Proportion of patients advised to follow a CVD prevention programme over the last 3 years (%)

  22. Therapeutic control of blood pressure* (%) * SBP/DBP <140/90 mmHg in patients using blood pressure lowering drugs 140/80 mmHg in diabetes

  23. Therapeutic control of total cholesterol* ( %) * Total cholesterol <4.5 mmol/L in patients using lipid lowering drugs

  24. Therapeutic control of LDL-cholesterol* ( %) * Total cholesterol <2.5 mmol/L in patients using lipid lowering drugs

  25. Prevalence of undetected diabetes at interview*(%) * Fasting glucose ≥7 mmol/L in patients not reporting a history of diabetes

  26. Prevalence of impaired fasting glycaemia*(%) * No self-reported or newly detected diabetes and fasting glucose ≥6.1 but <7 mmol/L

  27. Therapeutic control of diabetes - HbA1c <7%

  28. Conclusions • Cause for concern • No change in prevalence of smoking, obesity and central obesity with more then 80% of high CVD risk patients being overweight or obese • No improvement in therapeutic control of blood pressure, LDL-cholesterol and diabetes • Large heterogeneity between countries • Call for action • There is a pressing need for modern preventive cardiology programme integrating lifestyle and medical risk factor management adapted to medical and cultural settings in each country • Urgent need of health care systems that invest in prevention

  29. EUROASPIRE IV Steering CommitteeExecutive Committee Kornelia Kotseva (Chair Scientific Steering Committee) (UK) Guy De Backer (Chair Executive Committee) (Belgium) Philippe Amouyel (France) Dirk De Bacquer (Belgium) Stephan Gielen (Germany) Aldo Maggioni (Italy) Lars Ryden (Sweden) Oliver Schnell (Germany) JoukoSundvall (Helsinki) JaakkoTuomilehto (Finland) David Wood (Principal Investigator) (UK) Speaker

  30. EUROASPIRE IV Steering Committee National coordinators • Bulgaria: Nina Gotcheva • Croatia: Željko Reiner, Davor Milicic • Poland: Andrzej Pajak • Romania: Dan Gaita, Silvia Mancas • United Kingdom: David Wood Speaker

  31. EUROASPIRE IV Steering Committee Coordinating centre Cardiovascular Medicine, International Centre for Circulatory Health Imperial College, London, UK David Wood Kornelia Kotseva Catriona Jennings Agnieszka Adamska Data management centre EURObservational Research Programme, European Heart House, Sophia-Antipolis, France Thierry Ferreira Myriam Glemot Marème Konte Statistical Centre Department of Public Health, Ghent University, Belgium Dirk De Bacquer Speaker

  32. EUROASPIRE IV Steering CommitteeDiabetes centre Cardiology unit, Department of Medicine, Karolinska Institutet, Stockholm Sweden Lars Rydén Viveca Gyberg Jaakko Tuomilehto Oliver Schnell Central Laboratory Laboratory of Analytical Biochemistry, National Public Health Institute Helsinki, Finland Jouko Sundvall Laura Lund Speaker

  33. EUROASPIRE Sponsors The EUROASPIRE survey as an ESC initiative was supported by: • EUROASPIRE III: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck/Schering-Plough, Novartis, Pfizer, Sanofi-Aventis, and Servier • EUROASPIRE IV Amgen, AstraZeneca/Bristol-Myers Squibb, F. Hoffman-La Roche, GlaxoSmithKline, and Merck Sharp & Dohme

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