Clinical reality of primary prevention in people at high cardiovascular risk in

EuropeA comparison of EUROASPIRE III and IV surveys

in general practice

Kornelia Kotseva National Heart and Lung Institute, Imperial College London, UK

on behalf of EUROASPIRE IV Investigators

EURObservational Research Programme

Disclosure Statement of Financial Interest

• Grant/Research Support

• European Society of Cardiology

Within the past 12 months, I have had a financial Within the past 12 months, I have had a financial interest/arrangement or affiliation with the healthcare related interest/arrangement or affiliation with the healthcare related company listed belowcompany listed below..

European recommendations and surveys on cardiovascular disease prevention

1994 First Joint Task Force Recommendations

1994 Joint European Societies Implementation Group on Coronary Prevention

1995–96 EUROASPIRE I

1998 Second Joint Task Force Recommendations

1999–2000 EUROASPIRE II

2000 Joint European Societies CVD Prevention Committee

2003 Third Joint Task Force GuidelinesJoint European Societies CVD Prevention

Committee

2006–2007 EUROASPIRE III

2007 Fourth Joint Task Force Guidelines

2012 Fifth Joint Task Force Guidelines

20132013 ––1515 EUROASPIRE IV – European survey of CVD EUROASPIRE IV – European survey of CVD

prevention and diabetesprevention and diabetes

The EUROASPIRE surveys

identifies risk factors in high risk individuals

describes their management through lifestyle and use of drug therapies

providing objective assessment of clinical implementation of current knowledge

EUROASPIRE Surveys

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

• Consecutive patients, men and women <80 years

• No history of coronary or other atheroscleroticdisease

• Prescribed one or more of the following medications≥6 months 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

Methods

• Height, weight • Waist circumference• Blood pressure • Breath CO • Fasting venous blood sample for serum total

cholesterol, HDL-cholesterol, triglycerides, glucose and HbA1c

Data Collection

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

Outcome Measures

EUROASPIRE III & IV CountriesBulgaria, Croatia, Poland, Romania, UK

Survey Time period

Patients Womenn (%)

Age (years) mean±SD

EUROASPIRE IIIEUROASPIRE III 2007-2008 1985 1194 (60) 58±10

EUROASPIRE IVEUROASPIRE IV 2014-2015 1842 1002 (54) 59±12

Study Population

Prevalence of smoking* at interview (%)

* Self-reported smoking or CO in breath > 10 ppm

No intention to quit smoking* (%)

* Among current smokers

Prevalence of overweight* (%)

* Body mass index ≥25 kg/m2

Prevalence of obesity* (%)

* Body mass index ≥30 kg/m2

Prevalence of central obesity* (%)

* Waist circumference ≥88/102 cm women/men

Obese patients ever been told by a health care professional that their diet is unhealthy (%)

* Body mass index ≥30 kg/m2

Obese patients ever been told by a health care professional that they are overweight (%)

* Body mass index ≥30 kg/m2

Obese patients actively trying to lose weight in the last month (%)

* Body mass index ≥30 kg/m2

Obese patients considering trying to lose weight in the next month (%)

* Body mass index ≥30 kg/m2

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

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.

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

Therapeutic control of blood pressure* (%)

* SBP/DBP <140/90 mmHg in patients using blood pressure lowering drugs140/80 mmHg in diabetes

Therapeutic control of total cholesterol* ( %)

* Total cholesterol <4.5 mmol/L in patients using lipid lowering drugs

Therapeutic control of LDL-cholesterol* ( %)

* Total cholesterol <2.5 mmol/L in patients using lipid lowering drugs

Prevalence of undetected diabetes at interview* (%)

* Fasting glucose ≥7 mmol/L in patients not reporting a history of diabetes

Prevalence of impaired fasting glycaemia*(%)

* No self-reported or newly detected diabetes andfasting glucose ≥6.1 but <7 mmol/L

Therapeutic control of diabetes - HbA1c <7%

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

EURObservational Research Programme

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)Jouko Sundvall (Helsinki)Jaakko Tuomilehto (Finland)David Wood (Principal Investigator) (UK)

Speaker

Speaker

• Bulgaria: Nina Gotcheva • Croatia: Željko Reiner, Davor Milicic• Poland: Andrzej Pajak• Romania: Dan Gaita, Silvia Mancas• United Kingdom: David Wood

EUROASPIRE IV Steering Committee

National coordinators

EURObservational Research Programme

Cardiovascular Medicine, International Centre for Circulatory

Health Imperial College, London, UKDavid Wood Kornelia Kotseva Catriona Jennings Agnieszka Adamska

Data management centre EURObservational Research Programme, European Heart

House, Sophia-Antipolis, FranceThierry Ferreira Myriam GlemotMarème Konte

Statistical Centre Department of Public Health, Ghent University, Belgium

Dirk De Bacquer

Speaker

EUROASPIRE IV Steering Committee Coordinating centre

EURObservational Research Programme

Cardiology unit, Department of Medicine, Karolinska Institutet,Stockholm Sweden

Lars Rydén Viveca Gyberg Jaakko Tuomilehto Oliver Schnell

Central LaboratoryLaboratory of Analytical Biochemistry, National Public Health InstituteHelsinki, Finland

Jouko Sundvall Laura Lund

Speaker

EUROASPIRE IV Steering CommitteeDiabetes centre

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 IVAmgen, AstraZeneca/Bristol-Myers Squibb,

F. Hoffman-La Roche, GlaxoSmithKline, and Merck Sharp & Dohme