II European Action on Secondary and Primary Prevention through Intervention to Reduce Events Euro Heart Survey Programme European Society of Cardiology-ESC 1
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Priorities of Coronary Heart Disease Prevention in Clinical Practice 1. Patients with established CHD or other atherosclerotic disease 2. Healthy individuals who are at high risk of developing CHD or other atherosclerotic disease, because of risk factors - including smoking, raised blood pressure, lipids (raised total cholesterol and LDL-cholesterol, low HDL-cholesterol and raised triglycerides) raised blood glucose, family history of premature coronary disease - or who have severe hypercholesterolaemia, or other forms of dyslipidaemia, hypertension or diabetes 3. Close relatives of patients with early-onset CHD or atherosclerotic disease healthy individuals at particularly high risk 4. Other individuals met in connection with ordinary clinical practice 3
Goals for primary and secondary prevention of CHD (1) Lifestyle * Stop smoking * Make healthy food choices * Be physically active Other risk factors * Blood pressure < 140/90 mmhg * Total cholesterol < 5.0 mmol/l (190 mg/dl) * LDL cholesterol < 3.0 mmol/l (115 mg/dl) * Good glucose control in diabetes To be achieved by changes in lifestyle and, if needed, by drug treatment 4
Goals for secondary and primary prevention of CHD (2) Other prophylactic drug therapies Secondary prevention :! Secondary Prevention - Aspirin in virtually all patients - Beta-blockers after myocardial infarction - ACE inhibitors in patients with heart failure/lv dysfunction - Anticoagulants in patients at high risk of thromboembolic events! Primary prevention Aspirin (75 mg) in treated hypertensive patients and in men at particularly high CHD riskprevention : 5
Goals for primary and secondary prevention of CHD (3) Screen close relatives of * Patients with premature CHD (men < 55 yr and women < 65 yr) * Patients with suspected familial dyslipidaemias 6
II Principal Scientific Objective To determine in patients with CHD whether the major risk factors for recurrent CHD are being effectively managed by lifestyle and, when appropriate, drug therapy 7
II Study population Patients hospitalised because of 1) First elective or emergency CABG 2) First elective or emergency PTCA, no previous CABG 3) AMI, no previous CABG or PTCA 4) Acute myocardial ischaemia, no previous CABG, PTCA or AMI 8
II Study population # Consecutive patients, aged < 71 yrs, hospitalised in the period from 1st January 1997 to at least 6 months prior to the interview # Interviews: September 1999 - February 2000 # Median time between index event and interview:1.44 yrs (interquartile range 0.96-1.95 yrs) 9
II Participating centres Belgium -Ghent Czech Republic -Pilsen, Prague Finland -Kuopio France - Lille, Lomme, Roubaix Germany -Münster Greece - Athens, Thessaloniki, Crete, Ioannina Hungary -Budapest Ireland -Dublin Italy - Treviso, Verona the Netherlands - Rotterdam Poland - Cracow Slovenia - Ljubljana Spain -Barcelona Sweden -Malmö United Kingdom -Hull, London 10
Number of interviewed patients 260 Total = 5,556 patients 410 348 365 402 391 389 345 258 357 427 446 404 392 362 0 100 200 300 400 500 600 700 11 800
% smoking* at interview ALL 23 19 22 24 17 25 30 26 15 28 18 15 18 21 18 21 0 20 40 60 80 100 * self-reported and/or CO in breath > 10 ppm 12
Distribution of BMI at interview 30 kg/m² 25-30 kg/m² ALL 27 40 34 38 31 28 37 27 24 28 27 28 34 27 38 31 48 47 49 52 47 45 42 52 51 42 51 51 51 51 44 48 0 20 40 60 80 100 13
% raised blood pressure* at interview ALL 37 44 42 43 48 50 48 49 52 48 52 51 55 63 62 62 0 20 40 60 80 100 * systolic BP 140 mmhg and/or diastolic BP 90 mmhg 14
Therapeutic control of blood pressure at interview % reaching goal* at interview among those using BP lowering medication ALL 36 36 38 44 55 57 50 52 51 50 49 52 55 49 49 63 0 20 40 60 80 100 * systolic BP < 140 mmhg and diastolic BP < 90 mmhg 15
% total cholesterol 5 mmol/l at interview 43 60 60 66 65 73 77 ALL 40 44 54 57 53 54 58 64 68 0 20 40 60 80 100 16
Therapeutic control of total cholesterol at interview % reaching goal* at interview among those using lipid-lowering medication 31 39 44 70 41 42 48 49 49 55 66 ALL 41 52 54 51 65 0 20 40 60 80 100 * total cholesterol < 5 mmol/l 17
% self-reported diabetes at interview ALL 9 14 14 13 15 14 22 19 21 21 22 21 20 24 28 35 0 20 40 60 80 100 18
% aspirin/other anti-platelets at interview ALL 75 82 81 82 81 90 88 86 86 92 93 92 87 86 92 86 0 20 40 60 80 100 19
% beta-blockers at interview ALL 47 48 47 44 55 60 68 61 62 66 64 63 77 74 84 88 0 20 40 60 80 100 20
% ACE inhibitors at interview ALL 30 24 32 27 22 19 27 39 38 38 47 45 48 52 57 59 0 20 40 60 80 100 21
% lipid-lowering drugs at interview ALL 42 49 47 51 57 64 68 68 62 60 58 65 69 61 76 77 0 20 40 60 80 100 22
% statins at interview ALL 31 35 39 43 45 63 61 66 61 57 56 60 68 55 74 75 0 20 40 60 80 100 23
% anti-coagulants at interview ALL 3 4 11 3 5 4 11 4 1 6 9 6 9 4 7 16 0 20 40 60 80 100 24
II Conclusions! A high prevalence of unhealthy lifestyles, modifiable risk factors and inadequate use of prophylactic drug therapies is found in coronary patients across Europe! Considerable potential to raise the standard of preventive cardiology exists throughout Europe in order to reduce coronary morbidity and mortality 25
II Steering Group Pr Guy De Backer, Chairperson Pr Giovanni B Ambrosio Pr Philippe Amouyel Pr Dennis Cokkinos Pr Jaap Deckers Pr Leif Erhardt Pr Ian Graham Pr Irena Keber Pr Ulrich Keil Dr Seppo Lehto Dr Erika Ostör Pr Andrzej Pajak Pr Kalevi Pyörälä Dr Susana Sans Pr Jaroslav Simon Pr David Wood, Coordinator 26
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