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Craciun LM, Buleu F, Pah AM, Badalica-Petrescu M, Bodea O, Man DE, Cosor OC, Iurciuc S, Dragan S, Rada M. The Benefits of a Comprehensive Cardiac Rehabilitation Program for Patients with Acute Coronary Syndrome: A Follow-Up Study. J Pers Med 2023; 13:1516. [PMID: 37888127 PMCID: PMC10608079 DOI: 10.3390/jpm13101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Secondary prevention after acute coronary syndrome (ACS) is essential to reduce cardiovascular mortality and hospital readmission, ensuring patients return to normal with an improved quality of life. Thus, we investigate the benefits of a comprehensive cardiac rehabilitation (CR) program on lifestyle, risk factors and adherence to guideline-directed medical therapy (GDMT) in patients after ACS and myocardial revascularization through coronary artery by-pass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS This is a prospective, longitudinal study in consecutive post-CABG or PCI patients after ACS that participated or not in a comprehensive CR. Cardiovascular risk factors, quality of life and adherence to GDMT were analyzed in terms of assessing the benefit of 12 months of comprehensive CR on reaching guidelines secondary prevention targets. RESULTS At the inclusion in comprehensive CR of all patients (n = 480), 85% had hypertension; 86% had elevated total cholesterol values; 69% were characterized by metabolic syndrome; 43% were obese; 31% were active smokers and 29% had type 2 diabetes mellitus. Only 26.66% (n = 128) followed the entire program for 12 months. No statistically significant differences in the prescription of GDMT at hospital discharge after myocardial revascularization between the CR (+) group (n = 128) versus CR (-) group (n = 352) (p > 0.05) were observed. After 12 moths, a significant adherence to GDMT in the CR (+) group vs. CR (-) group was recorded, as follows: antiplatelet agents (100% versus 96%, p = 0.001), beta-blockers (99% versus 92%, p = 0.02), ACE inhibitors/ARAB (89% versus 79%, p = 0.04), lipid-lowering drugs (100% versus 89%, p = 0.001). In total, 82% of the CR (+) patients had a significantly higher adherence at GDMT (82% versus 64%, p = 0.001). At 12 moths, the CR (+) group was characterized by significantly lower values than at the inclusion but some values still increased: systolic blood pressure (139.25 + 19.20 mmHg (p < 0.03)), total cholesterol (171.07 + 48.59 mg/dL (p = 0.0001)) and LDL-cholesterol (102.83 + 41.30 mg/dL (p = 0.009)). At the same time, the analysis of psychosocial factors using the HAD questionnaire revealed a statistically significant improvement in anxiety and depression scores: HAD-A score (9.1 ± 3.7 at T0 vs. 7.1 ± 4.2 at T1, p = 0.001) and HAD-D score (7.7 ± 3.19 at T0 vs. 6.4 ± 4.3 at T1, p = 0.003). A multivariable analysis, following GDMT, showed the actual value or information and training of patients regarding optimal cardiovascular risk factor control was independently associated with lower values of systolic blood pressure (R2 = 0.48), diastolic (R2 = 0.38), serum glucose (R2 = 0.48), glycated hemoglobin (R2 = 0.50), total cholesterol (R2 = 0.31), LDL-cholesterol (R2 = 0.30), HDL-cholesterol (R2 = 0.19) and serum triglycerides (R2 = 0.20). CONCLUSION The twelve-month participation of post-ACS patients in comprehensive CR resulted in excellent post-revascularization management, as well as good adherence to guideline-directed medical therapy, provided further confirmation of the benefit of secondary prevention. Despite high adherence to drug treatments, targets for blood pressure, total cholesterol and LDL-cholesterol are inadequately achieved. Therefore, in the era of personalized medicine, patients with ACS should benefit from specific, comprehensive cardiovascular recovery programs that contain physiotherapists, psychologists, nutritionists and an experienced cardiologist in cardiovascular rehabilitation.
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Affiliation(s)
- Laura Maria Craciun
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Florina Buleu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Ana Maria Pah
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Marius Badalica-Petrescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Olivia Bodea
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Dana Emilia Man
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
- Research Center of the Timisoara Institute of Cardiovascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana Catalina Cosor
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Stela Iurciuc
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Simona Dragan
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
- Research Center of the Timisoara Institute of Cardiovascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria Rada
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
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Zhao M, Vaartjes I, Klipstein-Grobusch K, Kotseva K, Jennings C, Grobbee DE, Graham I. Quality assurance and the need to evaluate interventions and audit programme outcomes. Eur J Prev Cardiol 2018; 24:123-128. [PMID: 28618906 DOI: 10.1177/2047487317703829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.
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Affiliation(s)
- Min Zhao
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Ilonca Vaartjes
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
| | - Kerstin Klipstein-Grobusch
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,4 Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kornelia Kotseva
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom.,6 Department of Public Health, University of Ghent, Belgium
| | - Catriona Jennings
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Diederick E Grobbee
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
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Sikic J, Stipcevic M, Vrazic H, Cerkez Habek J, Margetic E, Gulin D. Nutrition in primary and secondary prevention of cardiovascular risk in the continental and Mediterranean regions of Croatia. BMC Cardiovasc Disord 2017; 17:247. [PMID: 28915786 PMCID: PMC5603055 DOI: 10.1186/s12872-017-0678-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/07/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of this observational study was to evaluate the effect of Mediterranean and continental nutrition on cardiovascular risk in patients with acute and chronic coronary heart disease in Croatia. METHODS The study included 1284 patients who were hospitalized in a 28-month period due to acute or chronic ischaemic heart disease in hospitals across Croatia. An individual questionnaire was prepared which enabled recording of various cardiovascular risk factors. RESULTS Patients with chronic coronary artery disease have a better index of healthy diet than patients with acute coronary disease. Women have a better index of diet than men in both Croatian regions. When the prevalence of risk factors (impaired glucose tolerance, diabetes mellitus types I and II, hypercholesterolaemia, hypertriglyceridaemia and hypertension) in patients with Mediterranean and continental nutrition is compared, a trend is seen for patients who have risk factors to consume healthier food. CONCLUSION The Mediterranean diet is associated with reduced risk of developing cardiovascular disease. This effect is more evident in patients with known cardiovascular disease.
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Affiliation(s)
- Jozica Sikic
- Division of Cardiology, Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mira Stipcevic
- Division of Cardiology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Hrvoje Vrazic
- Division of Cardiology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Jasna Cerkez Habek
- Division of Cardiology, Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia
| | - Eduard Margetic
- University Clinic of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Dario Gulin
- Division of Cardiology, Department of Internal Medicine, Sveti Duh University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Boban M, Laviano A, Persic V, Rotim A, Jovanovic Z, Vcev A. Characteristics of NRS-2002 Nutritional Risk Screening in patients hospitalized for secondary cardiovascular prevention and rehabilitation. J Am Coll Nutr 2014; 33:466-73. [PMID: 25387165 DOI: 10.1080/07315724.2013.876902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of our study was to assess the prevalence and characteristics of nutritional risk in patients scheduled for cardiovascular rehabilitation. BACKGROUND Knowledge concerning nutritional aspects of cardiovascular diseases is contemporary limited. METHODS Nutritional risk screening using a standardized Nutritional Risk Screening-2002 (NRS-2002) questionnaire was performed on a cohort of consecutive patients scheduled for rehabilitation 1-6 months after treatment for ischemic, valvular, or combined causes of heart diseases. Baseline weight was available for more than 80% of patients. RESULTS The study population consisted of 317 patients, aged 23-85 years, with a mean age of 62.5 ± 11.3 years. Male to female share was 253 (79.8%) and 64 (20.2%), respectively. Twenty-eight (8.8%) were treated for myocardial infarction conservatively, 151 (47.6%) by percutaneous coronary interventions, and 145 (45.7%) by surgery. NRS-2002 was 3.56 ± 1.54 in range 0-6. A high correlation was found between the NRS-2002 and percentage weight loss history (rho = 0.813; p <0.001). Significant differences according to increased nutritional risk (NRS-2002 ≥ 3) were found within age groups (p < 0.001), disease etiology (p = 0.002), cardiovascular treatments (p < 0.001), and grades of renal function (p < 0.001). Odds for developing increased nutritional risk (NRS-2002 ≥ 3) were significant for cardiovascular treatments (odds ratio [OR] = 4.35, 95% confidence interval [CI], 2.28-8.30, p < 0.001), age (OR = 3.19, 95% CI, 2.00-5.09, p < 0.001), grade of renal function (OR = 1.91, 95% CI, 1.17-3.09, p = 0.009), diabetes mellitus (OR = 2.37, 95% CI, 1.09-5.16, p = 0.029), and any psychological disturbance (OR = 2.04, 95% CI, 1.06-3.90, p = 0.032). CONCLUSIONS Pronounced nutritional risk frequently existed among patients at stationary cardiovascular rehabilitation. Nutritional risk was connected with preceding cardiovascular treatments, patient age, and renal function. Further studies concerning nutritional risk and its connections with clinical outcomes might serve as a resourceful perspective to improve outcomes or quality of care for the entities from the cardiovascular diseases continuum.
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Reiner Ž, Tedeschi-Reiner E. Prevalence and types of persistent dyslipidemia in patients treated with statins. Croat Med J 2013; 54:339-45. [PMID: 23986274 PMCID: PMC3760657 DOI: 10.3325/cmj.2013.54.339] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim To determine the prevalence and types of persistent dyslipidemia in patients treated with different statins to reduce cardiovascular disease (CVD) risk, as well as to determine the proportion of high risk patients who did not reach the lipid target values and assess cardiologists' further treatment advice for these patients. Methods This cross-sectional, observational study recruited 1849 outpatients from all parts of Croatia between January and September 2011 (44.6% women), 19 to 90 years old (average age 63.13) treated with statins for at least 6 months. We analyzed how the potency and type of lipid-lowering treatment were correlated with CVD risk level and achieving treatment goals according to 2007 Joint European Guidelines on CVD prevention. Results Most patients (81.3%) were at high risk for CVD. The most frequently used statin was atorvastatin (42.8%), followed by simvastatin (27.6%) and rosuvastatin (22.8%). Only 35.5% patients achieved low density lipoprotein-cholesterol treatment target. Patients treated with more potent statins had better results. A total of 22.3% of patients had high density lipoprotein-cholesterol below 1.0 mmol/L ( ~ 40 mg/dL) for men and below 1.2 ( ~ 45 mg/dL) for women and 46.4% had triglycerides above 1.7 mmol/L ( ~ 150 mg/dL) but there were no significant differences between statins in improving these parameters. Most of the patients on more potent statins were not advised by their cardiologists to change the type or dosage of statin, which was more common in patients on less potent statins. Conclusion A considerable number of patients treated with statins did not achieve the treatment goal values. The results were better in patients treated with more potent statins and cardiologists advised them much less frequently to change the type and dosage of statin. There is a need for more intensive treatment, especially for high-risk patients. This could be accomplished by optimizing patients’ adherence, using more potent statins, titrating current statin therapy to higher doses, or using a combined lipid-lowering treatment.
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Affiliation(s)
- Željko Reiner
- Zeljko Reiner, Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia,
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Reiner Ž, De Bacquer D, Kotseva K, Prugger C, De Backer G, Wood D. Treatment potential for dyslipidaemia management in patients with coronary heart disease across Europe: Findings from the EUROASPIRE III survey. Atherosclerosis 2013; 231:300-7. [DOI: 10.1016/j.atherosclerosis.2013.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 12/19/2022]
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Boban M, Persic V, Miletic B, Kovacicek K, Madzar Z. Heart surgery stems increased nutritional risk, expressed during the course of stationary rehabilitation. ANNALS OF NUTRITION AND METABOLISM 2013; 63:17-24. [PMID: 23867581 DOI: 10.1159/000350044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/20/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiovascular diseases are a vast global health burden. Despite common prevalence, current knowledge and investigations concerning nutritional aspects are limited. Characteristics and dynamics of nutritional risk are not entirely known for most of the entities, disease stages or treatment-induced fluctuations. This study assessed the effects of heart surgery on unintentional weight loss and nutritional risk using the NRS-2002. METHODS A noninterventional study that included patients scheduled for rehabilitation 1-6 months after heart surgery was performed. Evaluation included routine cardiovascular diagnostics and review of medical histories. Documented baseline weight was available for >85% of the patients. Nutritional risk screening was performed with the standardized NRS-2002 questionnaire. RESULTS A total of 145 patients were involved, with a mean age of 65.3 ± 11.5 years in a range of 23-84 years. The male to female ratio was 121:24 (83.4%:16.6%), respectively. Coronary artery bypass graft surgery (CABG) was performed in 89 patients (61.4%), valvular surgery (VS) in 34 (23.4%) and combined operations (CABG + VS) in 22 (15.2%). Percentage weight loss history was 11.1 ± 3.4% in a range of 0-20.1%, while NRS-2002 was 4.77 ± 1.05 in a range of 1-6. Increased nutritional risk (NRS-2002 ≥3) was found in nearly all patients. Combined ischemic and valvular etiology displayed the highest values of NRS-2002 (5.0 ± 1.2). Patient age and creatinine showed significant correlations with NRS-2002 (Rho = 0.521, p < 0.001 and Rho = 0.335, p < 0.001, respectively). CONCLUSION Increased nutritional risk was found to be frequently prevalent in patients scheduled for rehabilitation after heart surgery. Risk was found to be in relation with underlying coronary artery disease as well as with the age of patients and parameters of renal function. Routine application of nutritional risk screening appears to be a valuable clinical tool for detecting this relevant comorbidity, particularly since no connection was found with traditional anthropometrics.
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Affiliation(s)
- M Boban
- Department of Cardiology, University Hospital 'Thalassotherapia Opatija', Opatija, Croatia
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Zannad F, Dallongeville J, Macfadyen RJ, Ruilope LM, Wilhelmsen L, De Backer G, Graham I, Lorenz M, Mancia G, Morrow DA, Reiner Z, Koenig W. Prevention of cardiovascular disease guided by total risk estimations--challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy. Eur J Prev Cardiol 2013; 19:1454-64. [PMID: 23310961 PMCID: PMC3573669 DOI: 10.1177/1741826711424873] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the ‘treat-to-target’ paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and ‘real-world’ populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.
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Affiliation(s)
- Faiez Zannad
- Centre d'investigation Clinique, Institut Lorrain du Coeuret des Vaisseaux, CHU Brabois, Vandoeuvre, France.
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Pećin I, Whittall R, Futema M, Sertić J, Reiner Ž, Leigh SEA, Humphries SE. Mutation detection in Croatian patients with Familial Hypercholesterolemia. Ann Hum Genet 2012; 77:22-30. [DOI: 10.1111/j.1469-1809.2012.00735.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 08/25/2012] [Indexed: 02/03/2023]
Affiliation(s)
- Ivan Pećin
- Department of Internal Medicine; University Hospital Center Zagreb; Croatia
| | - Ros Whittall
- Centre for Cardiovascular Genetics; British Heart Foundation Laboratories, The Rayne Building; Royal Free and University College London Medical School; London; WC1E 6JJ; UK
| | - Marta Futema
- Centre for Cardiovascular Genetics; British Heart Foundation Laboratories, The Rayne Building; Royal Free and University College London Medical School; London; WC1E 6JJ; UK
| | - Jadranka Sertić
- Center for Clinical and Laboratory Diagnostics; University Hospital Center Zagreb; Croatia
| | - Željko Reiner
- Department of Internal Medicine; University Hospital Center Zagreb; Croatia
| | - Sarah E. A. Leigh
- Centre for Cardiovascular Genetics; British Heart Foundation Laboratories, The Rayne Building; Royal Free and University College London Medical School; London; WC1E 6JJ; UK
| | - Steve E. Humphries
- Centre for Cardiovascular Genetics; British Heart Foundation Laboratories, The Rayne Building; Royal Free and University College London Medical School; London; WC1E 6JJ; UK
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Reiner Ž, Sonicki Z, Tedeschi-Reiner E. The perception and knowledge of cardiovascular risk factors among medical students. Croat Med J 2012; 53:278-84. [PMID: 22661142 PMCID: PMC3378972 DOI: 10.3325/cmj.2012.53.278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To assess perceptions, knowledge, and awareness of cardiovascular disease (CVD) risk factors among medical students (freshmen and graduating students). METHODS A descriptive cross-sectional survey based on an anonymous self-administered questionnaire was conducted in 2008 on 443 medical students - 228 freshmen on their enrollment day and 214 students on the day of their final exam at the University of Zagreb School of Medicine, Croatia. RESULTS The perception and knowledge of some CVD risk factors, eg, dyslipidemia, arterial hypertension, and metabolic syndrome as well as of lipid-lowering therapy important for CVD prevention was significantly better among graduating students but was still not sufficient. Only 66% of graduating students reported that they would prescribe lipid-lowering therapy to high risk patients. Disappointingly, many graduating students were smoking (30.4%) and had low-awareness of obesity as an important CVD risk factor. CONCLUSION These results suggest an urgent need to improve medical students' knowledge of obesity and low physical activity as important CVD risk factors and of the methods for increasing low high-density lipoprotein-cholesterol and for smoking cessation. All this provides a rationale for modifying the university core curriculum to include more information concerning these issues.
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Affiliation(s)
- Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
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Perrone-Filardi P, Poli A, Ambrosio G, Proto C, Chimini C, Chiariello M. Implementation of cardiovascular secondary prevention guidelines in clinical practice: a nationwide survey in Italy. Nutr Metab Cardiovasc Dis 2012; 22:149-153. [PMID: 20875948 DOI: 10.1016/j.numecd.2010.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/15/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
AIMS To report the implementation of cardiovascular secondary prevention guidelines following a cardiovascular event in Italy. METHODS AND RESULTS Data were collected from 878 consecutive patients, who had suffered a cardiovascular event requiring hospitalisation in the preceding 12-24 months and who presented at 49 outpatient clinics across Italy. Cardiovascular risk markers were assessed through clinical examination, interview and reviewing of patients' charts; in addition, we collected information on changes in prevalence of selected risk factors that occurred since the time of index event. At the time of evaluation, increased body mass index (BMI) was observed in 35% of patients, with 20% being obese; 26% had diabetes and 21% uncontrolled hypertension. Although 91% of patients were on statins, no measurement of low-density lipoprotein (LDL)-cholesterol was available in the previous 6 months in 27% of patients and 16% had no knowledge of any lipid parameter in the same period. In the remaining patients, LDL was <100 mg dl(-1) in 57% and <70 mg dl(-1) in 20% of them. From the time of index event to interview, prevalence of uncontrolled hypertension remained stable, from 24% to 21% of patients; according to the patients' self-reporting, smoking had declined from 32% to 13% of patients and physical inactivity from 43% to 33% of patients. CONCLUSIONS This survey shows, in a large national cohort, a suboptimal implementation of lifestyle changes and inadequate lipid control in patients at high cardiovascular risk after a cardiovascular event. Reinforcement of patients and physicians, implementation and adherence to guidelines is needed to reduce the burden of cardiovascular disease.
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Affiliation(s)
- P Perrone-Filardi
- Department of Internal Medicine, Cardiovascular Sciences and Immunology, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
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Bergman Marković B, Vrdoljak D, Kranjcević K, Vucak J, Kern J, Bielen I, Ivezić Lalić D, Katić M, Reiner Z. Continental-Mediterranean and rural-urban differences in cardiovascular risk factors in Croatian population. Croat Med J 2012; 52:566-75. [PMID: 21853552 PMCID: PMC3160703 DOI: 10.3325/cmj.2011.52.566] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. Methods A multicenter prospective study was performed on 2467 participants of both sexes ≥40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. Results Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P < 0.001), obesity (P = 0.001), increased waist circumference (P < 0.001), and more intense physical activity (P = 0.020). Participants from coastal rural areas had higher HDL-cholesterol, participants from continental rural and coastal urban areas had higher LDL-cholesterol, and participants from rural continental had significantly higher BMI and waist circumference. Conclusion Prevalence of CVD risk factors in Croatian population is high. Greater burden of risk factors in continental region and rural areas may be partly explained by lifestyle differences.
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Affiliation(s)
- Biserka Bergman Marković
- Department of Family Medicine, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
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Shu DF, Dong BR, Lin XF, Wu TX, Liu GJ. Long-term beta blockers for stable angina: systematic review and meta-analysis. Eur J Prev Cardiol 2011; 19:330-41. [PMID: 22779086 DOI: 10.1177/1741826711409325] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives: To assess the effects of long-term beta blockers in patients with stable angina. Methods: We reviewed the literature up to June 2010 from CENTRAL, MEDLINE, EMBASE, CBM, and CNKI for randomized controlled trials. The appropriate data were meta-analysed using Revman 5.0. Results: Twenty-six trials including 6108 patients were identified. The treatment with beta blockers has significantly decreased all-cause mortality when compared with no control (OR 0.40, 95% CI 0.20 to 0.79), but has had no statistically differences when compared with placebo (OR 0.92, 95% CI 0.62 to 1.38) and with calcium-channel blocker (CCB) (OR 0.84, 95% CI 0.49 to 1.44). This was similar in patients with fatal and non-fatal acute myocardial infarction when compared with placebo (OR 0.82, 95% CI 0.57 to 1.17) or CCB (OR 1.08, 95% CI 0.71 to 1.66); on revascularization and quality of life. The beta blockers reduced the incident of unstable angina compared to no treatment (OR 0.14, 95% CI 0.07 to 0.29), but increased unstable angina compared to placebo (OR 3.32, 95% CI 1.50 to 7.36). There was a significant reduction of nitrate consumption when beta blockers were compared with CCBs (OR −1.18, 95% CI −1.54 to −0.82), but not with placebo and trimetazidine. There was no significant difference in angina attack between each group. Side effects in beta blocker were similar with ones in controls. Conclusions: Beta blockers may decrease the death and unstable angina when compared with no treatment, but no more effective than other anti-anginal agents on prophylaxis of myocardial ischaemia in stable angina patients.
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Affiliation(s)
- De Fen Shu
- Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Rong Dong
- Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiu Fang Lin
- Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Tai Xiang Wu
- Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Guan Jian Liu
- Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, Chengdu, China
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High prevalence of metabolic syndrome in an elderly Croatian population - a multicentre study. Public Health Nutr 2010; 14:1650-7. [PMID: 21138612 DOI: 10.1017/s1368980010003265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the prevalence and characteristics of metabolic syndrome (MetS) in a healthy elderly Croatian population. DESIGN Cross-sectional study consisting of a health check including anthropometric measures and food questionnaires as well as analysis of biochemical parameters related to MetS. The diagnostic criteria of the International Diabetes Federation (IDF) were used for diagnosis of MetS. SETTING Four centres in continental (Virovitica and Zagreb) and Adriatic coast (Split and Omiš) regions of Croatia. SUBJECTS Free-living elderly persons aged 70-90 years (n 320). RESULTS Significantly lower MetS prevalence was found among participants from small urban centres compared with those from large urban centres (59·1 % v. 69·6 %; P = 0·051). Participants without MetS consumed wine more frequently (P = 0·05) than those with MetS. Compared with their peers with HDL cholesterol (HDL-C) <1·03 mmol/l, more male participants with HDL-C ≥1·03 mmol/l consumed wine (P = 0·04) or pelagic fish (P = 0·03). The prevalence of participants with TAG ≥1·7 mmol/l was higher in wine non-consumers (P = 0·05) than in wine consumers. Multivariate analysis with age and gender as covariates showed a significant inverse association of wine consumption with total cholesterol (P < 0·001), a positive association with HDL-C (P < 0·001) and a marginally inverse association with TAG (P = 0·06). In the male population, alkaline phosphatase and γ-glutamyl transferase activities were higher in participants with MetS (P < 0·05). CONCLUSIONS High MetS prevalence was observed in an elderly Croatian population. Data showed that moderate consumption of wine and/or pelagic fish has a protective role against MetS in the population studied.
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Reiner Ž, Sonicki Z, Tedeschi-Reiner E. Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: The PERCRO-DOC survey. Atherosclerosis 2010; 213:598-603. [DOI: 10.1016/j.atherosclerosis.2010.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 08/08/2010] [Accepted: 09/16/2010] [Indexed: 11/17/2022]
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Reiner Z, Sonicki Z, Tedeschi-Reiner E. Public perceptions of cardiovascular risk factors in Croatia: the PERCRO survey. Prev Med 2010; 51:494-6. [PMID: 20951724 DOI: 10.1016/j.ypmed.2010.09.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/28/2010] [Accepted: 09/29/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Since there are almost no data about the perceptions and attitudes of the general public concerning risk factors for cardiovascular diseases (CVD) this survey was performed. METHOD Face-to-face interviews were conducted based upon a questionnaire with 883 members of the general population from different parts of Croatia in October-November 2008. RESULTS 36.1% of them correctly identified CVD as the leading cause of death but the most feared disease was cancer (40.0%). CVD was on the second place with only 21.6%. 30.9% was aware that elevated LDL-cholesterol increases CVD risk but 49.0% knew that high HDL-cholesterol is beneficial. 43.3% knew their total cholesterol (TC) value and 74.4% knew their blood pressure (BP). 30.9% knew what their target TC should be and 33.9% knew what their target BP should be. The knowledge about TC and BP target values was positively associated with higher educational level. 53.2% of the general public reported that they have never discussed any CVD risk factor with their physician. CONCLUSION These data suggest insufficient awareness of CVD risk factors in general population and a need for improved promotion of CVD prevention. To achieve this people and physicians should be motivated by the health authorities and/or insurance companies.
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Affiliation(s)
- Zeljko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia.
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Trends in vascular risk factors and medication use in patients with various manifestations of vascular diseases or type 2 diabetes mellitus from 1996 to 2007: the Second Manifestations of ARTerial disease study. ACTA ACUST UNITED AC 2010; 17:628-36. [DOI: 10.1097/hjr.0b013e328336a0f8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guideline-recommended secondary prevention drug therapy after acute myocardial infarction: predictors and outcomes of nonadherence. ACTA ACUST UNITED AC 2010; 17:576-81. [DOI: 10.1097/hjr.0b013e328338e5da] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Controlling lipids in a high-risk population with documented coronary artery disease for secondary prevention: are we doing enough? ACTA ACUST UNITED AC 2010; 17:556-61. [DOI: 10.1097/hjr.0b013e328338978e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Positive change in the utilization of antihypertensive and lipid-lowering drugs among adult CHD patients in Finland: results from a large national database between 2000 and 2006. ACTA ACUST UNITED AC 2010; 17:477-85. [PMID: 20220527 DOI: 10.1097/hjr.0b013e328336a138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To assess the changes in the utilization of antihypertensive, and lipid-lowering drugs among all adult Finnish coronary heart disease (CHD) patients between 2000 and 2006, and to evaluate the treatment and control of hypertension and dyslipidemia in a population-based sample of CHD patients. METHODS From the databases of the Social Insurance Institution of Finland, 192,440 CHD patients aged 30 years or more in 2000 and 206,394 in 2006, respectively, were identified. Changes in the utilization of antihypertensive and lipid-lowering drugs were determined. In addition, from the Health 2000 Survey representing the whole Finnish population aged 30 years or more, 527 CHD patients were identified, to assess their characteristics and control of hypertension and dyslipidemia. RESULTS Between the fall of 2000 and spring of 2001, 75% of the CHD patients were classified as hypertensives and 85% of these used antihypertensive medication. From 2000 to 2006, the utilization of lipid-lowering, and antihypertensive drugs increased from 33 to 52% and from 74 to 78%, respectively. Moreover, combination antihypertensive medication increased from 37 to 48%. Amidst the patients using antihypertensive drugs, the use of renin-angiotensin system blockers increased from 27 to 46% because of more than a three-fold increase in the use of angiotensin receptor blockers. CONCLUSION Utilization of antihypertensive agents (especially angiotensin receptor blockers) and lipid-lowering drugs has increased remarkably by the end of 2006. However, the treatments are still far from optimal.
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Wong N, Vulić D, Šobot M. Implementation of secondary prevention methodologies in ischemic heart disease. SCRIPTA MEDICA 2010. [DOI: 10.5937/scrimed1001029w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Reiner Z. How to improve cardiovascular diseases prevention in Europe? Nutr Metab Cardiovasc Dis 2009; 19:451-454. [PMID: 19631516 DOI: 10.1016/j.numecd.2009.06.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 06/15/2009] [Indexed: 11/25/2022]
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EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. ACTA ACUST UNITED AC 2009; 16:121-37. [PMID: 19287307 DOI: 10.1097/hjr.0b013e3283294b1d] [Citation(s) in RCA: 599] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM The aim of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey was to determine whether the Joint European Societies' guidelines on cardiovascular prevention are being followed in everyday clinical practice and to describe the lifestyle, risk factor and therapeutic management in patients with coronary heart disease (CHD) in Europe. METHODS The EUROASPIRE III survey was carried out in 2006-2007 in 76 centres from selected geographical areas in 22 countries in Europe. Consecutive patients, with a clinical diagnosis of CHD, were identified retrospectively and then followed up, interviewed and examined at least 6 months after their coronary event. RESULTS Thirteen thousand nine hundred and thirty-five medical records (27% women) were reviewed and 8966 patients were interviewed. At interview, 17% of patients smoked cigarettes, 35% were obese and 53% centrally obese, 56% had a blood pressure >or=140/90 mmHg (>or=130/80 in people with diabetes mellitus), 51% had a serum total cholesterol >or=4.5 mmol/l and 25% reported a history of diabetes of whom 10% had a fasting plasma glucose less than 6.1 mmol/l and 35% a glycated haemoglobin A1c less than 6.5%. The use of cardioprotective medication was: antiplatelets 91%; beta-blockers 80%; angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 71%; calcium channel blockers 25% and statins 78%. CONCLUSION The EUROASPIRE III survey shows that large proportions of coronary patients do not achieve the lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention. Wide variations in risk factor prevalences and the use of cardioprotective drug therapies exist between countries. There is still considerable potential throughout Europe to raise standards of preventive care in order to reduce the risk of recurrent disease and death in patients with CHD.
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Social Support and Change in Vascular Risk Factors in Patients with Clinical Manifestations of Vascular Diseases. Eur J Cardiovasc Nurs 2009; 8:137-43. [DOI: 10.1016/j.ejcnurse.2008.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/23/2022]
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Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373:929-40. [PMID: 19286092 DOI: 10.1016/s0140-6736(09)60330-5] [Citation(s) in RCA: 618] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice. METHODS EUROASPIRE I, II, and III were designed as cross-sectional studies and included the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, and Slovenia. Consecutive patients (men and women </=70 years) were identified after coronary artery bypass graft or percutaneous coronary intervention, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. FINDINGS 3180 patients were interviewed in the first survey, 2975 in the second, and 2392 in the third. Overall, the proportion of patients who smoke has remained nearly the same (20.3% in EUROASPIRE I, 21.2% in II, and 18.2% in III; comparison of all surveys p=0.64), but the proportion of women smokers aged less than 50 years has increased. The frequency of obesity (body-mass index >/=30 kg/m(2)) increased from 25.0% in EUROASPIRE I, to 32.6% in II, and 38.0% in III (p=0.0006). The proportion of patients with raised blood pressure (>/=140/90 mm Hg in patients without diabetes or >/=130/80 mm Hg in patients with diabetes) was similar (58.1% in EUROASPIRE I, 58.3% in II, and 60.9% in III; p=0.49), whereas the proportion with raised total cholesterol (>/=4.5 mmol/L) decreased, from 94.5% in EUROASPIRE I to 76.7% in II, and 46.2% in III (p<0.0001). The frequency of self-reported diabetes mellitus increased, from 17.4%, to 20.1%, and 28.0% (p=0.004). INTERPRETATION These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease. Despite a substantial increase in antihypertensive and lipid-lowering drugs, blood pressure management remained unchanged, and almost half of all patients remain above the recommended lipid targets. To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention.
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Affiliation(s)
- Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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Bergovec M, Reiner Ž, Miličić D, Vražić H. Differences in risk factors for coronary heart disease in patients from continental and Mediterranean regions of Croatia. Wien Klin Wochenschr 2008; 120:684-92. [DOI: 10.1007/s00508-008-1065-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
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Barandon L, Calderon J, Lafitte M, Leroux L, Cadusseau JL, Roques X, Couffinhal T. Assessing cardiovascular risk factors after coronary artery bypass surgery: value of an aggressive strategy including systematic follow-up. Arch Cardiovasc Dis 2008; 101:155-62. [PMID: 18477942 DOI: 10.1016/s1875-2136(08)71797-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coronary revascularization surgery is a palliative treatment modality which should not preclude efforts to treat atherosclerosis. AIM To assess ongoing cardiovascular risk factors after coronary artery bypass surgery and develop a strategy to attenuate such factors. METHODS 108 patients requiring a coronary artery bypass were included: 2 died soon after surgery and 6 were excluded for personal reasons. 100 patients were re-admitted into hospital 7 months after surgery for risk factor assessment. Eight months later, they were re-contacted by telephone (systematic follow-up) for a re-assessment. RESULTS The population consisted of 77 men with an average age of 64+/-11 years. Prior to the operation, the known risk factors were: smoking 34%; HBP 61%; cholesterol 47%; diabetes 30%; obesity 25%. During their hospital stay six months after the procedure: 91% of the patients had at least one lipid metabolism abnormality. New-onset diabetes was diagnosed in 5%. Blood pressure was uncontrolled in 18% and 10% were still smoking. Patients tended to be putting on weight and 55% engaged in little or no physical activity. Systematic follow-up: lipid metabolism had normalized in 70% of the patients. Blood glucose levels were significantly lower. Blood pressure was uncontrolled in 9% and 4% were still smoking. Their weight had stabilized and 65% were engaging in moderate-to-strenuous physical activity. CONCLUSION Inadequate attention is paid to risk factors after coronary artery bypass surgery. A short hospital stay including a cardiovascular evaluation and education about risk factors has a positive impact on the management of atherosclerosis in the medium term.
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Affiliation(s)
- L Barandon
- Département de chirurgie cardiaque, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, Pessac.
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Reiner Z. Statins in heart failure - a failure? Nutr Metab Cardiovasc Dis 2008; 18:397-401. [PMID: 18579352 DOI: 10.1016/j.numecd.2008.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 03/27/2008] [Accepted: 04/10/2008] [Indexed: 11/23/2022]
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Merkler M, Reiner Ž. The burden of hyperlipidaemia and diabetes in cardiovascular diseases. Fundam Clin Pharmacol 2007; 21 Suppl 2:1-3. [DOI: 10.1111/j.1472-8206.2007.00529.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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