Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry

Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.

[1]  L. Rydén,et al.  Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart , 2008, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[2]  S. Yusuf,et al.  Association of Diet, Exercise, and Smoking Modification With Risk of Early Cardiovascular Events After Acute Coronary Syndromes , 2010, Circulation.

[3]  C. Morrison,et al.  Waist circumference as a measure for indicating need for weight management , 1995, BMJ.

[4]  D. Cook,et al.  Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. , 2000, Archives of internal medicine.

[5]  C. Jennings,et al.  Accuracy of a Simplified Glucose Measurement Device--The HemoCue Glucose 201RT. , 2015, Diabetes technology & therapeutics.

[6]  Shah Ebrahim,et al.  Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) , 2007 .

[7]  R. Peters,et al.  Community-Based Lifestyle Intervention in Patients With Coronary Artery Disease: The RESPONSE-2 Trial. , 2017, Journal of the American College of Cardiology.

[8]  Dirk De Bacquer,et al.  Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey , 2018, European journal of preventive cardiology.

[9]  Wei Li,et al.  Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. , 2013, JAMA.

[10]  Deepak L. Bhatt,et al.  Modifiable risk factors control and its relationship with 1 year outcomes after coronary artery bypass surgery: insights from the REACH registry , 2008, European heart journal.

[11]  Lawrence A Leiter,et al.  Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada , 2012, European journal of preventive cardiology.

[12]  Shah Ebrahim,et al.  [European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)]. , 2013, Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir.

[13]  Roberto Ferrari,et al.  The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. , 2004, European heart journal.

[14]  A. Hoes,et al.  Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial. , 2014, European heart journal.

[15]  Marcus R. Munafo,et al.  Smoking cessation interventions for hospitalized smokers: a systematic review. , 2008, Archives of internal medicine.

[16]  S. Yusuf,et al.  WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE). , 2005, Bulletin of the World Health Organization.

[17]  K. Kotseva,et al.  EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries , 2009, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[18]  Shah Ebrahim,et al.  JOINT ESC GUIDELINES 2016 European Guidelines on cardiovascular disease prevention in clinical practice – Web Addenda , 2016 .

[19]  Dragan,et al.  EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from twenty four European countries , 2016 .

[20]  Shah Ebrahim,et al.  European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) , 2012, International Journal of Behavioral Medicine.

[21]  M. Taskinen,et al.  [ESC/EAS Guidelines for the management of dyslipidaemias]. , 2011, Revista espanola de cardiologia.

[22]  J. Tardif,et al.  Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: Data from the contemporary CLARIFY registry , 2015, European journal of preventive cardiology.

[23]  D. Wood,et al.  Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries , 2001, The Lancet.

[24]  O. Faergeman,et al.  Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial , 2008, The Lancet.

[25]  G. Mancia,et al.  European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force Of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). , 2004, Archives des maladies du coeur et des vaisseaux.

[26]  Stefan Störk,et al.  EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries , 2016, European journal of preventive cardiology.

[27]  P. Poole‐Wilson,et al.  Prevention of coronary heart disease in clinical practice , 1994 .

[28]  D. Atar,et al.  JOINT ESC GUIDELINES 2016 European Guidelines on cardiovascular disease prevention in clinical practice – Web Addenda , 2016 .

[29]  A. Morice,et al.  Breath carbon monoxide as an indication of smoking habit. , 2000, Chest.

[30]  C. Held,et al.  Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study , 2013, European journal of preventive cardiology.

[31]  EUROASPIRE. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. EUROASPIRE Study Group. European Action on Secondary Prevention through Intervention to Reduce Events. , 1997, European heart journal.

[32]  Ian Graham,et al.  Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. , 1998, European heart journal.

[33]  Philippe Amouyel,et al.  A European Society of Cardiology survey of secondary prevention of coronary heart disease: Principal results. , 1997 .

[34]  Shah Ebrahim,et al.  Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) , 2007 .

[35]  J. De Sutter,et al.  Adverse Lifestyle Trends Counter Improvements in Cardiovascular Risk Factor Management in Coronary Patients. , 2015, Journal of the American College of Cardiology.

[36]  K. Kotseva,et al.  Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries , 2009, The Lancet.

[37]  David R. Wood,et al.  Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. , 2001, European heart journal.

[38]  J. Critchley,et al.  Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. , 2003, JAMA.

[39]  S. Yusuf,et al.  Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey , 2011, The Lancet.

[40]  A. Hoes,et al.  [Guidelines on cardiovascular disease prevention in clinical practice]. , 2005, Revue medicale de Liege.

[41]  P. Poole‐Wilson,et al.  Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. , 1994, Atherosclerosis.

[42]  A. Hoes,et al.  2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. , 2016, European heart journal.

[43]  R. Perera,et al.  Pharmacological interventions for smoking cessation: an overview and network meta-analysis. , 2013, The Cochrane database of systematic reviews.

[44]  G. Boysen,et al.  European Guidelines on Cardiovascular Disease Prevention , 2009, International journal of stroke : official journal of the International Stroke Society.

[45]  Ramon Luengo-Fernandez,et al.  European Cardiovascular Disease Statistics 2017 , 2012 .

[46]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.