Monday, September 3, 2007

ESC Congrss - News - EUROASPIRE reveals disappointing trends in CVD prevention

EUROASPIRE reveals disappointing trends in CVD prevention

3 September 2007

MedWire News: Results from EUROASPIRE presented at the European Society of Cardiology in Vienna, Austria, reveal disappointing trends in preventive cardiology in Europe over the past 12 years.

The EUROASPIRE series of surveys was conducted to measure the extent to which coronary artery disease (CAD) patients are managed to control risk factors and receive appropriate medical therapy with respect to guidelines.

The first survey was conducted in nine countries in 1994, the second in 15 countries in 2000, and the third in 22 countries in 2006-2007.

David Wood (Imperial College London, UK) presented a comparison of data from the same centers in the same eight countries – Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, and Slovenia – that participated in all three surveys.

A total of 8547 CAD patients, who had undergone coronary artery bypass graft surgery or angioplasty, suffered a myocardial infarction, or ischemia, and were aged on average 61 years, were interviewed and examined over the 12-year period.

The results reveal worrying trends in lifestyle management.

The prevalence of smoking did not change overall, with around 20% of patients continuing to smoke in all three surveys. This hid a marked increase in the prevalence of smoking among younger patients under the age of 50 years and women, however, Wood noted.

Meanwhile, there was a “striking” increase in the prevalence of obesity, he observed, from 25.0% in the first survey to 32.6% in the second and 38.0% in the third. This corresponded to an increase in central obesity, from 42.2% to 53.0% and 54.9%, respectively.

The prevalence of hypertension, defined as blood pressure levels of 140/90 mmHg or above, or 130/80 mmHg or over in patients with diabetes, remained relatively constant, at around 60%.

Self-reported diabetes increased from 17.4% to 20.1% and 28.0% in the first, second, and third surveys, respectively. But Wood said that systematic screening revealed a further 15% of the rest of the patients had undetected diabetes, and some two-thirds had evidence of glycemia. Furthermore, less than 10% of patients with diabetes had their condition adequately controlled.

In marked contrast, there were striking improvements in lipid management according to recommended levels for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). The prevalence of elevated TC and LDL-C dropped from 94.5% to 76.7% and 46.2%, and from 96.4% to 78.1% and 47.5%, respectively.

Similarly, there were “encouraging” increases in the use of antiplatelets, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers, Wood noted.

But, he pointed out, this begs the obvious question of why it was not reflected in terms of a cut in uncontrolled blood pressure and diabetes. Summing up the results, Wood said that the increase in obesity may be an important mitigating factor in the reduced blood pressure control and increase in prevalence of diabetes.

He noted that less than one third of CAD patients have access to structured preventive and rehabilitative care programs, and that the findings illustrate the pressing need for such preventive cardiology programs.

“We invest a huge amount of effort in rescuing patients with acute ischemic heart disease conditions, we should make the same effort in addressing the underlying causes of the disease,” Wood concluded.

European Society of Cardiology Annual Congress 2007; Vienna, Austria: 1-5 Sept

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