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Marques-Vidal P, Jankowski P, Reiner Ž, De Bacquer D, Kotseva K. Dietary management of patients at high risk for cardiovascular disease; EUROASPIRE V. Clin Nutr ESPEN 2023; 55:144-150. [DOI: 10.1016/j.clnesp.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
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Vynckier P, De Sutter J, De Pauw M, Vandekerckhove H, De Backer G, Vervaet P, Deweerdt N, Dendale P, Persu A, Janssen A, Chenu P, Kotseva K, Gevaert S, De Bacquer D, De Smedt D. Gender differences in risk factor management and pharmacological treatment among CHD patients: Belgian results of the EUROASPIRE IV and EUROASPIRE V surveys. Acta Cardiol 2023:1-7. [PMID: 36779380 DOI: 10.1080/00015385.2023.2169439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
AIMS The aim of this study was to provide an up-to-date overview of gender differences or similarities in risk factor control and medical management in the Belgian CHD population. METHODS All analyses are based on the ESC EORP EUROASPIRE IV and EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) surveys. Patients between 18 and 80 years old, hospitalised for a first or recurrent coronary event, were included in the survey. RESULTS Data were available for 10,519 patients, of which 23.9% were women. Women had a worse risk factor profile compared to men. Women were more physical inactive (OR = 1.31, 95% CI = 1.19-1.44), had a higher prevalence of obesity (OR = 1.37, 95% CI = 1.25-1.50) and had a worse LDL-C control (OR = 1.52, 95% CI = 1.36-1.70). Moreover, women were less likely to use ACE-I/ARBs (OR = 0.84, 95% CI = 0.76-0.94) and statins (OR = 0.79, 95% CI = 0.70-0.90). In addition, little gender differences were found in patients' risk factor awareness, except on cholesterol awareness. Women were more aware about their total cholesterol levels (OR = 1.37, 95% CI = 1.21-1.56). CONCLUSION Despite little to no gender differences in the management of CHD patients, women still have a worse risk factor profile, both in Belgian and in other European high-income countries.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares, Gent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Michel De Pauw
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Pieter Vervaet
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital and University of Hasselt, Hasselt, Belgium
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institute de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Arne Janssen
- Heart Centre Hasselt, Jessa Hospital and University of Hasselt, Hasselt, Belgium
| | - Patrick Chenu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institute de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Ungethüm K, Wiedmann S, Wagner M, Leyh R, Ertl G, Frantz S, Geisler T, Karmann W, Prondzinsky R, Herdeg C, Noutsias M, Ludwig T, Käs J, Klocke B, Krapp J, Wood D, Kotseva K, Störk S, Heuschmann PU. Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys. Clin Res Cardiol 2023; 112:285-298. [PMID: 36166067 PMCID: PMC9898414 DOI: 10.1007/s00392-022-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. METHODS The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). RESULTS 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). CONCLUSION Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.
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Affiliation(s)
- K Ungethüm
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany.
| | - S Wiedmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Berlin, Germany
| | - M Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Kuratorium für Dialyse und Nierentransplantation E.V, Neu-Isenburg, Hesse, Germany
| | - R Leyh
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - G Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - S Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
| | - T Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - W Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Bavaria, Germany
| | - R Prondzinsky
- Cardiology/Intensive Care Medicine, Carl Von Basedow Klinikum Merseburg, Merseburg, Saxony-Anhalt, Germany
| | - C Herdeg
- Medius Klinik Ostfildern-Ruit, Klinik für Innere Medizin, Herz- und Kreislauferkrankungen, Ostfildern-Ruit, Baden-Württemberg, Germany
| | - M Noutsias
- Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Saxony-Anhalt, Halle (Saale), Germany
- Department of Internal Medicine A, University Hospital Ruppin-Brandenburg (UKRB) of the Medical School of Brandenburg (MHB), Neuruppin, Brandenburg, Germany
| | - T Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Käs
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - B Klocke
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - J Krapp
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
| | - D Wood
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - K Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- Imperial College Healthcare NHS Trusts, London, UK
- National University of Ireland, Galway, Ireland
| | - S Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - P U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Bavaria, Germany
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Bavaria, Germany
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Vynckier P, Van Wilder L, Kotseva K, Wood D, Gevaert S, Clays E, De Bacquer D, De Smedt D. Gender differences in health-related quality of life and psychological distress among coronary patients: Does comorbidity matter? Results from the ESC EORP EUROASPIRE V registry. Int J Cardiol 2023; 371:452-459. [PMID: 36087631 DOI: 10.1016/j.ijcard.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
AIMS This study aimed to provide an overview on contemporary gender differences in HRQoL/psychological distress and their relationship with comorbidity burden among European coronary heart disease (CHD) patients. METHODS Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey. Consecutive patients (aged 18-80 years), hospitalized for a first or recurrent coronary event were included in this study. Data at hospital discharge and at follow-up (6 to 24 months after hospitalisation) were collected. RESULTS Data were available for 8261 patients of which 25.8% women. Overall, women reported a worse EQ-5D-5L index score (0.73 vs. 0.81; P < 0.001), EQ-VAS (63.1 vs. 66.0; P = 0.001), global HeartQoL (1.94 vs. 2.26; P < 0.001), physical HeartQoL (1.96 vs. 2.30; P < 0.001), emotional HeartQoL (1.88 vs. 2.18; P < 0.001), HADS-A (6.69 vs. 4.99; P < 0.001), and HADS-D (5.73 vs. 4.62; P < 0.001) compared to men. Also, women were more likely to have comorbidities compared to men (1 comorbidity: 38.7% vs. 35.0%, 2 comorbidities: 9.7% vs. 7.5%; P < 0.001). There is indication that heart failure (EQ-VAS) and diabetes (global HeartQoL, emotional HeartQoL, physical HeartQoL, and HADS-D) interacted with gender and modulate the relationship with HRQoL, in disfavour of women. CONCLUSION Substantial gender-based health inequalities in terms of HRQoL and psychological distress were found, in disfavour of women. Women had worse HRQoL and psychological distress outcomes when having comorbidities. To a limited extent, comorbidity and women had a negative/synergistic effect on HRQoL. Special attention should be given to this population groups within daily clinical practice.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; Imperial College Healthcare NHS Trust, London, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; National Heart & Lung Institute Imperial College London, London, UK
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Ryden L. Measures of insulin resistance as a screening tool for dysglycaemia in patients with coronary artery disease. A report from the EUROASPIRE V population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The optimal screening strategy for dysglycaemia, including type 2 diabetes (T2DM) and impaired glucose tolerance (IGT), in patients with coronary artery disease (CAD) is debated.
Purpose
We tested the hypothesis that measures of insulin resistance by homeostasis model assessment (HOMA) indexes may constitute accurate screening methods in a CAD population.
Methods
Insulin, C-peptide, glycated haemoglobin A1c (HbA1c) and an oral glucose tolerance test (OGTT) were centrally assessed in 3534 CAD patients without known dysglycaemia from the EUROASPIRE V survey. Three different HOMA indexes were calculated: HOMA-IR, HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycaemia was diagnosed based on the two-hour postload glucose (2hPG) value obtained from the OGTT. Information on study participants was obtained by standardised visits. The optimal thresholds of the three HOMA indexes for dysglycaemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristics curves. The diagnostic performance of such thresholds was tested for both T2DM (i.e. in reference to a 2hPG value ≥11 mmol/L) and dysglycaemia (i.e. in reference to 2hPG value ≥7.8 mmol/L) and their correlation with several clinical parameters was assessed by Spearman's coefficients.
Results
The mean age of the patients was 63 years and 25% were women. Fifty-four percent of the patients had central obesity, 18% were current smokers, mean blood pressure was 133/80 mmHg and mean LDL-cholesterol 2.4 mmol/L. The OGTT revealed that 41% were dysglycaemic (IGT = 24% and T2DM = 16%). Mean insulin, C-peptide and HOMA indexes were significantly higher in patients with vs. without newly detected dysglycaemia (all p<0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycaemia were low and the associations between 2hPG and the other parameters in the total sample were weak, with Spearman correlation coefficients of 0.15 for fasting insulin, 0.19 for C-peptide, 0.24 for HOMA-IR, 0.18 for HOMA2-ins and 0.22 for HOMA2-Cpep. HOMA-IR, HOMA2-ins and C-peptide were strongly correlated with body mass index and waist circumference (Spearman correlation coefficients ranging 0.43–0.47).
Conclusion
Screening for dysglycaemia in CAD patients by insulin, C-peptide, HOMA-IR, HOMA2-ins and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycaemia with reference to the yield of an OGTT, which should still be prioritized. Further studies are warranted to assess whether measures of insulin resistance might be better markers of unfavourable metabolic derangement beyond dysglycaemia.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): European Society of CardiologyErling-Perssons Stiftelse
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Affiliation(s)
| | | | - I Erlund
- National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - V Gyberg
- Karolinska Institute , Stockholm , Sweden
| | - K Kotseva
- National University of Ireland Galway , Galway , Ireland
| | - L Mellbin
- Karolinska Institute , Stockholm , Sweden
| | | | - O Schnell
- University Hospital of Munich , Munich , Germany
| | - J Tuomilehto
- National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - T Vihervaara
- National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - D Wood
- National University of Ireland Galway , Galway , Ireland
| | - L Ryden
- Karolinska Institute , Stockholm , Sweden
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Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population. Diabetes Care 2022; 45:2111-2117. [PMID: 35771773 DOI: 10.2337/dc22-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. RESEARCH DESIGN AND METHODS Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients. RESULTS Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong. CONCLUSIONS Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Heart & Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Capio St Göran's Hospital, Stockholm, Sweden
| | | | - Jaakko Tuomilehto
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Terhi Vihervaara
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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De Bacquer D, Jennings CS, Mirrakhimov E, Lovic D, Bruthans J, De Smedt D, Gotcheva N, Dolzhenko M, Fras Z, Pogosova N, Lehto S, Hasan-Ali H, Jankowski P, Kotseva K, De Backer G, Wood D, Rydén L. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. Eur Heart J Qual Care Clin Outcomes 2022; 8:568-576. [PMID: 34315174 DOI: 10.1093/ehjqcco/qcab043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022]
Abstract
AIMS Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. METHODS AND RESULTS Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month. CONCLUSIONS The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Erkin Mirrakhimov
- Department of Cardiology and Internal Diseases, Kyrgyz State Medical Academy, Akhunbaev str. 92, 720020, Bishkek, Kyrgyzstan.,National Centre of Cardiology and Internal Medicine Named After Academician Mirrakhimov MM, Togolok Moldo str. 3, 720040, Bishkek, Kyrgyzstan
| | - Dragan Lovic
- Cardiology Department, Singidunum University, School of Medicine, Clinic for Internal Disease Intermedica, Jovana Ristica str. 20/2, 18000 Nis, Serbia
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Nina Gotcheva
- National Heart Hospital, Department of Cardiology, Konjovitza str. 65, 1309 Sofia, Bulgaria
| | - Maria Dolzhenko
- Shupyk National Medical Academy of Postgraduate Education, Dorohozhytska 9, 04112, Kyiv, Ukraine
| | - Zlatko Fras
- Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Zaloška 7, SI-1525 Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nana Pogosova
- National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, 3-rd Cherepkovskaya str. 15A, 121552 Moscow, Russia
| | - Seppo Lehto
- Department of Internal Medicine, Lapland Central Hospital, Ounasrinteentie 22, 96400 Rovaniemi, Finland
| | - Hasan Hasan-Ali
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut University Campus, 71515 Assiut, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, 2 Jakubowski Str., 30-688 Kraków, Poland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland - Galway, Croí Heart & Stroke Centre, Croí House, Moyola Lane, Newcastle, Galway H91 FF68, Ireland.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, FoU - Tema Hjärta och Kärl, S1:02, Karolinska Universitetssjukhuset/Solna, SE-171 76, Stockholm, Sweden
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Vynckier P, Kotseva K, Gevaert S, De Bacquer D, De Smedt D. Gender differences in cardiovascular risk factor awareness. Results from the ESC EORP EUROASPIRE V registry. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Fonds voor hartchirurgie - Fonds pour la Chirurgie Cardiaque
Background
Risk factor awareness among coronary patients is related to a decreased risk of recurrent coronary events and hence important in the secondary prevention of coronary heart disease (CHD). Whereas previous studies demonstrated gender differences in disfavour of women with regard to patients’ risk factor control, little is known about gender differences in patients’ risk factor awareness.
Purpose
The aim of this study was to document potential gender differences across Europe in patients’ risk factor awareness and information provided by healthcare professionals.
Methods
Analyses were based on data from the most recent ESC EORP EUROASPIRE V survey (European Survey Of Cardiovascular Disease Prevention And Diabetes, 2016-17). Consecutive patients hospitalized for a first or recurrent coronary event or surgical procedure between 18-80 years old at the time of identification were retrospectively identified in 27 countries. Awareness of risk factor levels were defined as patients’ self-reported awareness about their latest weight, waist circumference, blood pressure, total cholesterol, blood glucose levels, and HbA1c levels. Data on risk factor awareness and information provided by healthcare professionals were obtained from patient interviews (6 months to 2 years prior to the date of the study visit). Logistic regression analyses were performed adjusting for age and medical history (stroke, heart failure, and diabetes).
Results
Information was available on 8,261 patients, including 25.8% women. Women were significantly older (65.4 vs. 63.0 years) and were more likely to have a history of stroke (5.3% vs. 3.7%; P=0.002), heart failure (7.6% vs. 5.9%; P=0.006), and self-reported diabetes (33.1% vs. 28.0%; P<0.001). Overall, no significant gender differences were found regarding the information provided by a healthcare professional on overweight, diabetes, and chronic kidney disease, whereas, a higher proportion of women with hypertension (≥140/80 (≥140/85 if diabetes)) (OR=2.07, 95% CI=4.60-2.68) and women with raised cholesterol levels (LDL-C ≥1.8mmol/L) (OR=1.31, 95% CI=1.14-1.51) were informed about their raised risk factor levels. Furthermore, women with obesity were less aware about their actual weight (OR= 0.66, 95% CI=0.52-0.85) and weight target level (OR= 0.66, 95% CI=0.54-0.81) than men. In contrast, no significant gender differences in awareness of waist circumference levels were found in obese patients neither for fasting blood glucose or HbA1c levels in patients with self-reported diabetes. Women with hypertension and those found with raised LDL-C levels were more aware about their target blood pressure level (OR=1.21, 95% CI=1.01-1.46) and actual cholesterol level (OR=1.18, 95% CI=1.02-1.36).
Conclusions
Our study reveals only little gender differences in disfavour of women in terms of information provided by healthcare professionals and risk factor awareness.
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Affiliation(s)
| | - K Kotseva
- National University of Ireland, Galway, Ireland
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9
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Ferrannini G, De Bacquer D, Gyberg V, De Backer G, Kotseva K, Mellbin LG, Risebrink R, Tuomilehto J, Wood D, Rydén L. Saving time by replacing the standardised two-hour oral glucose tolerance test with a one-hour test: Validation of a new screening algorithm in patients with coronary artery disease from the ESC-EORP EUROASPIRE V registry. Diabetes Res Clin Pract 2022; 183:109156. [PMID: 34843858 DOI: 10.1016/j.diabres.2021.109156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS An oral glucose tolerance test (OGTT) combining fasting (FPG) and 2-hour plasma glucose (2hPG) is the most sensitive method for detecting type 2 diabetes (T2DM). Since it is considered time-consuming, we aim at validating a previously proposed screening algorithm based on a 1-hour plasma glucose (1hPG) with a 12 mmol/L threshold. METHODS Nine-hundred-eighteen patients with coronary artery disease (CAD) without known T2DM from the EUROASPIRE V cross-sectional survey underwent an OGTT. The reference for T2DM was 2hPG ≥ 11.1 mmol/L. T2DM diagnosis by HbA1c ≥ 6.5%(48 mmol/mol), FPG ≥ 7.0 mmol/L, and 1hPG ≥ 12 mmol/L were compared with the outcome of 2hPG. RESULTS Mean FPG, HbA1c and 2hPG were 6.1 mmol/L, 5.6%(38 mmol/mol) and 7.8 mmol/L respectively. Ninety-six patients (10%) were diagnosed with T2DM according to 2hPG. Using this definition, in the group with FPG < 6.5 mmol/L and 1hPG < 12 only 5 (1%) were misdiagnosed as false negatives. All patients with a FPG > 8.0 mmol/L and 1hPG > 15.0 mmol/L were identified as having T2DM. According to the algorithm, in 79% of patients T2DM could be excluded by combining FPG < 6.5 mmol/L and 1hPG < 12 mmol/L. CONCLUSIONS T2DM Screening by means of an algorithm combining FPG and 1hPG limits the demand of a 2hOGTT in 79% of CAD patients without known T2DM. HbA1c did not add to the information derived from this algorithm.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Viveca Gyberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, UK; St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Risebrink
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Finnish Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Yurdadogan T, Malsch C, Kotseva K, Wood D, Leyh R, Ertl G, Karmann W, Müller-Scholden L, Morbach C, Breunig M, Wagner M, Gelbrich G, Bots ML, Heuschmann PU, Störk S. Functional versus morphological assessment of vascular age in patients with coronary heart disease. Sci Rep 2021; 11:18164. [PMID: 34518567 PMCID: PMC8437950 DOI: 10.1038/s41598-021-96998-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 08/04/2021] [Indexed: 01/21/2023] Open
Abstract
Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VAPWVao in 68% of patients; for VAAIao in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VAtotal-cIMT accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.
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Affiliation(s)
- Tino Yurdadogan
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Rainer Leyh
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Lara Müller-Scholden
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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11
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McEvoy JW, Jennings C, Kotseva K, De Backer G, De Bacquer D, Erlund I, Lip GYH, Ray KK, Rydén L, Adamska A, Wood DA. INTERASPIRE: an International Survey of Coronary Patients; Their Cardiometabolic, Renal and Biomarker Status; and the Quality of Preventive Care Delivered in All WHO Regions : In Partnership with the World Heart Federation, European Society of Cardiology, Asia Pacific Society of Cardiology, InterAmerican Society of Cardiology, and PanAfrican Society of Cardiology. Curr Cardiol Rep 2021; 23:136. [PMID: 34410520 PMCID: PMC8374115 DOI: 10.1007/s11886-021-01568-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/11/2022]
Abstract
Purpose of Review To describe the INTERASPIRE scientific protocol—an international survey of secondary prevention of coronary heart disease (CHD). Recent Findings This international survey is being conducted through National Societies of Cardiology in selected countries from each of the six WHO regions and has the following overall aims: (i) describe prevalence of cardiometabolic and renal risk factors together with biomarkers in CHD patients; (ii) describe current risk factor management through lifestyle changes and cardioprotective drug therapies; (iii) provide an objective assessment of clinical implementation of preventive care by comparison with the lifestyle and risk factor targets defined in international and national guidelines; (iv) investigate the reasons for variation in preventive cardiology practice between regions and countries; and (v) promote the principles of best preventive cardiology practice. Summary This international survey will provide a unique picture of CHD patients; their cardiometabolic, renal and biomarker status; lifestyle and therapeutic management; and the quality of preventive care provided in all WHO regions.
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Affiliation(s)
- John William McEvoy
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland. .,Discipline of Medicine, Clinical Science Institute, National University of Ireland Galway, University Road, Galway, Ireland, H91 TK33.
| | - Catriona Jennings
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Gregory Y H Lip
- Arrhythmia Centre: Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Coordinating Centre for the FH Studies Collaboration: Department of Public Health and Primary Care, Imperial College, London, UK
| | - Lars Rydén
- Diabetes Centre: Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Agnieszka Adamska
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David A Wood
- Co-ordinating Centre: National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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12
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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13
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Abstract
PURPOSE OF REVIEW Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Canada. .,KITE-Toronto Rehabilitation Institute, Toronto, ON, Canada. .,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Mary A Whooley
- US Department of Veterans Affairs Quality Enhancement Research Initiative, San Francisco, USA.,University of California, San Francisco, USA
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14
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Curneen JM, Judge C, Traynor B, Buckley A, Saiva L, Murphy L, Murray D, Fleming S, Kearney P, Murphy RT, Aleong G, Kiernan TJ, O'Neill J, Moore D, Nicaodhabhui B, Birrane J, Hall P, Crowley J, Gibson I, Jennings CS, Wood D, Kotseva K, McEvoy JW. Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study). Open Heart 2021; 8:openhrt-2021-001659. [PMID: 34172561 PMCID: PMC8237732 DOI: 10.1136/openhrt-2021-001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes. Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods. Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation. Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.
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Affiliation(s)
- James Mg Curneen
- Clinical Pharmacology and Therapeutics, Galway University Hospital, Galway, Ireland
| | - Conor Judge
- Medicine, Galway University Hospital, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Bryan Traynor
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Anthony Buckley
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - Lavanya Saiva
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Laura Murphy
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Donal Murray
- Cardiology, Sligo University Hospital, Sligo, Ireland
| | - Sean Fleming
- Cardiology, Midland Regional Hospital Portlaoise, Portlaoise, Ireland
| | | | | | - Godfrey Aleong
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Thomas J Kiernan
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - James O'Neill
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - David Moore
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Bridog Nicaodhabhui
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John Birrane
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Patricia Hall
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - James Crowley
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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15
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Kozieł P, Jankowski P, Kosior DA, Sowa P, Szóstak-Janiak K, Krzykwa A, Sawicka E, Haberka M, Setny M, Kamiński K, Gąsior Z, Kubica A, De Bacquer D, De Backer G, Kotseva K, Wood D, Czarnecka D, Pająk A. Smoking cessation in patients with established coronary artery disease: data from the POLASPIRE survey. Kardiol Pol 2021; 79:418-425. [PMID: 33687865 DOI: 10.33963/kp.15854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Smoking cessation in patients with coronary artery disease (CAD) is related to decreased risk of cardiovascular events. AIMS To evaluate factors related to persistent smoking in patients with established coronary artery disease. METHODS Patients aged 80 years or younger and hospitalized for acute coronary syndrome or a myocardial revascularization procedure were interviewed 6 to 18 months after the recruiting event. Medical history, smoking behavior, and exposure to environmental smoke were assessed during the interview. Self--reported smoking status was validated by carbon monoxide in exhaled air measurement. Persistent smoking was defined as smoking at the time of interview among those who smoked during the month prior to the recruiting event. RESULTS We analyzed the data of 1034 patients, including 764 (73.9%) who reported smoking at any time in the past and 296 (28.6%) who smoked within 1 month before the recruiting hospitalization. At the time of the interview, the overall smoking rate was 17.2%, whereas 54.7% of patients were persistent smokers. Secondhand smoke exposure and duration of smoking were associated with lower likelihood whereas older age, high socioeconomic status, cardiac rehabilitation following a cardiovascular event, and consultation with a cardiologist were associated with higher likelihood of smoking cessation. CONCLUSIONS Over half of all smokers hospitalized for CAD are still smoking 6 to 18 months after discharge. Older age, secondhand smoking, low socioeconomic status, lack of consultation with a cardiologist, and cardiac rehabilitation following hospitalization were related to persistent smoking. Our findings may help develop strategies aimed at assisting smoking cessation in patients with CAD.
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Affiliation(s)
- Paweł Kozieł
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Jankowski
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland.
| | - Dariusz A Kosior
- Faculty of Medicine, Medical College, Cardinal Stefan Wyszyński University, Warsaw, Poland,Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Paweł Sowa
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | | | - Agnieszka Krzykwa
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Emilia Sawicka
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | - Maciej Haberka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Setny
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Karol Kamiński
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Białystok, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, United Kingdom,National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
| | - David Wood
- National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland,Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Danuta Czarnecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Pająk
- Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
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16
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Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Tuomilehto J, Wood D, Rydén L. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys. Cardiovasc Diabetol 2021; 20:38. [PMID: 33573665 PMCID: PMC7879645 DOI: 10.1186/s12933-021-01233-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Gender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Recent data from two nationwide cohorts of patients suggested no gender difference as regards the risk for diabetes-related CV complications but indicated the presence of a gender disparity in risk factor management. The aim of this study was to investigate gender differences in screening for dysglycaemia, cardiovascular risk factor management and prognosis in dysglycemic CAD patients. Methods The study population (n = 16,259; 4077 women) included 7998 patients from the ESC-EORP EUROASPIRE IV (EAIV: 2012–2013, 79 centres in 24 countries) and 8261 patients from the ESC-EORP EUROASPIRE V (EAV: 2016–2017, 131 centres in 27 countries) cross-sectional surveys. In each centre, patients were investigated with standardised methods by centrally trained staff and those without known diabetes were offered an oral glucose tolerance test (OGTT). The first of CV death or hospitalisation for non-fatal myocardial infarction, stroke, heart failure or revascularization served as endpoint. Median follow-up time was 1.7 years. The association between gender and time to the occurrence of the endpoint was evaluated using Cox survival modelling, adjusting for age. Results Known diabetes was more common among women (32.9%) than men (28.4%, p < 0.0001). OGTT (n = 8655) disclosed IGT in 17.2% of women vs. 15.1% of men (p = 0.004) and diabetes in 13.4% of women vs. 14.6% of men (p = 0.078). In both known diabetes and newly detected dysglycaemia groups, women were older, with higher proportions of hypertension, dyslipidaemia and obesity. HbA1c was higher in women with known diabetes. Recommended targets of physical activity, blood pressure and cholesterol were achieved by significantly lower proportions of women than men. Women with known diabetes had higher risk for the endpoint than men (age-adjusted HR 1.22; 95% CI 1.04–1.43). Conclusions Guideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.
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Affiliation(s)
- Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Viveca Gyberg
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Department of Neurobiology, Centre for Family Medicine, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, D2, 141 83, Huddinge, Sweden
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, University Road, Galway, H91 TK33, Republic of Ireland.,St Mary's Hospital, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, Paddington, London, W2 1NY, UK
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Heart, Vascular and Neuro Theme, Karolinska University Hospital, Eugeniavägen 3, 17164, Stockholm, Sweden
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden.,Capio St Görans Hospital, Sankt Göransplan 1, 11219, Stockholm, Sweden
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, University Road, Galway, H91 TK33, Republic of Ireland
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Solnavägen 1, 17177, Stockholm, Sweden
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17
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Kozieł P, Jankowski P, Mirek-Bryniarska E, Nessler J, Podolec P, De Bacquer D, Kotseva K, Wood D, Czarnecka D, Kawecka-Jaszcz K, Pająk A. Obesity in patients with established coronary artery disease over a 20-year period (1997-2017). Pol Arch Intern Med 2021; 131:26-32. [PMID: 33522218 DOI: 10.20452/pamw.15742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Body mass reduction in overweight and obese people so as to reduce blood pressure, low‑density lipoprotein cholesterol level, and the risk of type 2 diabetes as well as to lower the risk of recurrent cardiovascular events is strongly recommended in current guidelines. OBJECTIVES To evaluate changes in body mass index (BMI) and waist circumference in patients with established coronary artery disease over a 20‑year period (1997-2017). PATIENTS AND METHODS Consecutive patients younger than 71 years of age and hospitalized for acute coronary syndrome or myocardial revascularization procedures were recruited and interviewed 6 to 18 months after their discharge from hospital. Weight, height, and waist circumference were measured in 1997 to 1998, 1999 to 2000, 2006 to 2007, 2011 to 2013, and 2016 to 2017. The same 5 hospitals took part in the surveys each time. RESULTS We examined 412 patients in 1997 to 1998 (survey 1), 427 in 1999 to 2000 (survey 2), 422 in 2006 to 2007 (survey 3), 462 in 2011 to 2013 (survey 4), and 272 in 2016 to 2017 (survey 5). The proportion of obese patients was 24.5% in survey 1, 27.2% in survey 2, 34.1% in survey 3, 35.9% in survey 4, and 40.4% in survey 5 (P <0.001). The proportion of patients with central obesity also increased significantly (32.5% in survey 1, 40.5% in survey 2, 51.4% in survey 3, 48.6% in survey 4, and 61.3% in survey 5; P <0.001). BMI increased significantly in men, but not in women, whereas the mean waist circumference increased in both sexes. BMI and waist circumference increased irrespective of age and education. CONCLUSIONS The analysis of 5 multicenter surveys showed a gradual increase in BMI and waist circumference in patients with established coronary artery disease over the course of 2 decades.
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Affiliation(s)
- Paweł Kozieł
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Jankowski
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | | | - Jadwiga Nessler
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust and National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
| | - David Wood
- Imperial College Healthcare NHS Trust and National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
| | - Danuta Czarnecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Kalina Kawecka-Jaszcz
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Andrzej Pająk
- Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
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18
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Pogosova NV, Oganov RG, Boytsov SA, Ausheva AK, Sokolova OY, Kursakov AA, Osipova IV, Antropova ON, Pozdnyakov YM, Salbieva AO, Lelchuk IN, Gusarova TA, Gomyranova NV, Skazin NA, Kotseva K. Secondary prevention in patients with coronary artery disease in Russia and Europe: results from the Russian part of the EUROASPIRE V survey. Cardiovasc Ther Prev 2020. [DOI: 10.15829/1728-8800-2020-2739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - R. G. Oganov
- National Research Center for Therapy and Preventive Medicine
| | | | | | | | - A. A. Kursakov
- National Research Center for Therapy and Preventive Medicine
| | | | | | | | - A. O. Salbieva
- National Research Center for Therapy and Preventive Medicine
| | - I. N. Lelchuk
- National Research Center for Therapy and Preventive Medicine
| | - T. A. Gusarova
- National Research Center for Therapy and Preventive Medicine
| | | | | | - K. Kotseva
- National Institute for Prevention and Cardiovascular Health; National University of Ireland – Galway; Imperial College Healthcare NHS Trust
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19
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De Bacquer D, Ueda P, Reiner Ž, De Sutter J, De Smedt D, Lovic D, Gotcheva N, Fras Z, Pogosova N, Mirrakhimov E, Lehto S, Jernberg T, Kotseva K, Rydén L, Wood D, De Backer G. Prediction of recurrent event in patients with coronary heart disease: the EUROASPIRE Risk Model. Eur J Prev Cardiol 2020; 29:328-339. [PMID: 33623999 DOI: 10.1093/eurjpc/zwaa128] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with established atherosclerotic cardiovascular disease (CVD) are at very high risk for developing recurrent events. Since this risk varies a lot between patients there is a need to identify those in whom an even more intensive secondary prevention strategy should be envisaged. Using data from the EUROASPIRE IV and V cohorts of coronary heart disease (CHD) patients from 27 European countries, we aimed at developing and internally and externally validating a risk model predicting recurrent CVD events in patients aged < 75 years. METHODS AND RESULTS Prospective data were available for 12 484 patients after a median follow-up time of 1.7 years. The primary endpoint, a composite of fatal CVD or new hospitalizations for non-fatal myocardial infarction (MI), stroke, heart failure, coronary artery bypass graft, or percutaneous coronary intervention (PCI), occurred in 1424 patients. The model was developed based on data from 8000 randomly selected patients in whom the association between potential risk factors and the incidence of the primary endpoint was investigated. This model was then validated in the remaining 4484 patients. The final multivariate model revealed a higher risk for the primary endpoint with increasing age, a previous hospitalization for stroke, heart failure or PCI, a previous diagnosis of peripheral artery disease, self-reported diabetes and its glycaemic control, higher non-high-density lipoprotein cholesterol, reduced renal function, symptoms of depression and anxiety and living in a higher risk country. The model demonstrated excellent internal validity and proved very adequate in the validation cohort. Regarding external validity, the model demonstrated good discriminative ability in 20 148 MI patients participating in the SWEDEHEART register. Finally, we developed a risk calculator to estimate risks at 1 and 2 years for patients with stable CHD. CONCLUSION In patients with CHD, fatal and non-fatal rates of recurrent CVD events are high. However, there are still opportunities to optimize their management in order to prevent further disease or death. The EUROASPIRE Risk Calculator may be of help to reach this goal.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Peter Ueda
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Johan De Sutter
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Department of Cardiology, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - Dragan Lovic
- Cardiology Department, School of Medicine, Clinic for Internal Disease Intermedica, Hypertensive Centre, Singidunum University, Nis, Serbia
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Zlatko Fras
- Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nana Pogosova
- National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.,National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, London, UK.,National University of Ireland, Galway, Ireland
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Heart and Lung Institute, Imperial College London, London, UK.,National University of Ireland, Galway, Ireland
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
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20
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Jankowski P, Kozieł P, Bogacki P, Gomuła P, Mirek-Bryniarska E, Nessler J, Podolec P, De Bacquer D, De Backer G, Kotseva K, Wood D, Czarnecka D, Kawecka-Jaszcz K, Pająk A. Pharmacotherapy in patients with chronic coronary syndromes over a 20-year period (1997-2017). Kardiol Pol 2020; 78:1156-1158. [PMID: 32897036 DOI: 10.33963/kp.15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Vynckier P, Gevaert S, Kotseva K, Tokgozoglu L, De Bacquer D, De Smedt D. Risk factor management in coronary patients: results from the EUROASPIRE V survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previously, there has been a misperception that cardiovascular disease (CVD) mainly affects males. Although lately, there is increasing awareness about the risk of CVD in women, evidence suggests that the management of women with CVD is suboptimal.
Purpose
The aim of this study is to look at gender differences in treatment and risk factor control after a coronary event across countries with varying income levels.
Methods
Analyses were based on the ESC-EORP EUROASPIRE V survey, including patient information from 27 European countries. Patients included (18–80 years), were hospitalised for an ischaemic coronary event. Information on medical treatment, risk factors and behavioural changes were obtained during patient interviews (6 months to 2 years after hospitalization). Findings on treatment and risk factor control were compared with the European guidelines on CVD prevention (2016). Country classification by income level (low/medium income vs. high income) was done according to the World Bank Atlas method. Logistic regression analyses adjusted for sex, age, education level, country income, surgical intervention, stroke, heart failure and diabetes were performed.
Results
Data from 8261 coronary patients, of which 25.8% women, were included in the analyses. Mean (SD) age at the interview was 62.95 (9.72) years for men and 65.36 (9.21) years for women. First, when looking at the evidence based medication intake, no gender differences were seen in the prescription of antiplatelets/aspirin, whereas statins were more often prescribed in men (82.8% vs. 77.7%; p=0.002). A closer look by country income revealed that this difference is entirely due to the higher statin use among men from low/medium income countries (79.6% vs. 72.3%; p=0.004). Second, the risk factor profile differed substantially between genders. Overall, a worse risk factor profile was seen in women. Although, men were more likely to smoke (20.7% vs. 12.8%; p<0.001), women were less physically active (63.2% vs. 72.5%; p<0.001), had more obesity (34.9% vs. 45.7%; p<0.001) and central obesity (51.8% vs. 78.0%; p<0.001), and had a worse lipid control (65.9% vs. 74.3%; p<0.001). Overall, no gender differences were seen in diabetes prevalence and blood pressure control. A closer look at country income level showed that the gender difference in smoking prevalence dissolved in high income countries. In addition, women in low income countries were more likely to suffer from diabetes (26.7% vs. 38.9%; p<0.001).
Conclusion
These findings suggest a worse risk factor profile in women despite little to no gender differences in medical treatment. Further research is needed to understand the gender-differential in risk factor control.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Fonds voor hartchirurgie - Fonds pour la Chirurgie Cardiaque
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Affiliation(s)
| | | | - K Kotseva
- National University of Ireland, Galway, Ireland
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22
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Kotseva K, De Backer G, De Bacquer D, Grobbee D, Hoes A, Jennings C, Maggioni A, Marques-Vidal P, Ryden L, Wood D. Poor attainment of blood pressure, lipids and diabetes targets in people at high cardiovascular risk in Europe: a report from the ESC-EORP EUROASPIRE V Survey in 16 European countries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The EUROASPIRE V survey in primary care was carried out by the European Society of Cardiology, EURObservational Research Programme in 2017–2018 and investigated the risk factor management in patients at high cardiovascular (CVD) risk in16 European countries.
Purpose
To provide an audit the implementation of the 2016 Joint European Societies' guidelines on CVD prevention in people at high risk of developing CVD in primary care and to see whether the practice of preventive cardiology had improved by comparison with the previous EUROASPIRE IV survey in 2014–2015.
Methods
All patients were free of coronary or other atherosclerotic diseasebut considered at high CVD risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy.
Results
2,759high CVD risk individuals (58% females), mean age 59 (SD 12) years, were interviewed and examined (participation rate 70%). The risk factor control was very poor, with less than half (47%) of patients on blood pressurelowering medication reaching the target of <140/90 mmHg (<140/85 mmHg in people with self-reported diabetes). Among treated dyslipidaemic patients only 47% attained LDL-cholesterol target of <2.6 mmol/L. Among treated type 2 diabetic patients, 65% achieved the HbA1c target of <7.0mmol/L. However, many patients on no antihypertensive or lipid-lowering medications had elevated blood pressure (43%) and elevated LDL-cholesterol (81%), respectively. The use of blood pressure lowering medication in people with hypertension was: ACE inhibitors/ARBs 79%, beta-blockers 37%, diuretics 36% and calcium channel blockers 32%; with 42% on one, 34% on two, 18% on three and 6% on ≥4 blood pressure lowering drugs. Among people on lipid-lowering medication, statins were prescribed in 97% and fibrates in 3%. Less than two-thirds of patients reported complete adherence with the intake of their blood pressure and lipid-lowering medications. The comparison with EUROASPIRE IV in the same centres that took part in both surveys showed no change in the BP management. There was a slight improvement in the control of LDL-cholesterol and glucose in patients with diabetes.
Conclusions
The results of EUROASPIRE V clearly demonstrate that the control of blood pressure, LDL-cholesterol and diabetes in patients at high CVD risk remains poor with large proportions not achieving the targets defined in the prevention guidelines. There is a considerable potential to raise the standards of preventive cardiology and to improve the management of patients at high CVD risk in Europe.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Society of Cardiology
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Affiliation(s)
- K Kotseva
- National Institute of Preventive Cardiology, Galway, Ireland
| | | | | | - D Grobbee
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - A Hoes
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - C Jennings
- National Institute of Preventive Cardiology, Galway, Ireland
| | - A Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - P Marques-Vidal
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Ryden
- Karolinska Institute, Department of Medicine, Cardiology Unit, Stockholm, Sweden
| | - D Wood
- National Institute of Preventive Cardiology, Galway, Ireland
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23
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Moerschel K, De Bacquer D, De Backer G, Wood D, Kotseva K, Wellmann J, Prugger C. Predicting risk factor control in patients with coronary heart disease using patients' individual and large-area residential characteristics: results from the ESC-EORP EUROASPIRE V survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The impact of small-area residential characteristics on the development of coronary heart disease (CHD) and cardiovascular risk factors is well established. Evidence is so far lacking on the predictive value of large-area residential characteristics for cardiovascular risk.
Purpose
In CHD patients, we aimed to study the predictive value of large-area residential characteristics beyond patients' individual characteristics for the control of major cardiovascular risk factors (blood pressure, cholesterol and smoking).
Methods
Patients hospitalised for coronary events or interventions from 16 European countries were interviewed and examined for risk factor control (EUROASPIRE V survey). Based on patients' postal codes, we merged individual patient data with large-area residential data routinely provided by Eurostat for NUTS regions (Nomenclature of Territorial Units for Statistics). We selected patient characteristics recorded at hospitalisation (2015–16) and socioeconomic characteristics of their residential NUTS 2 and 3 regions (2015–16) to predict risk factor control at interview (2016–17). We developed risk prediction models using multi-level logistic regression: 1) baseline models (BMs) with patient data only and 2) extended models (EMs) with patient data (level 1) and large-area residential data (level 2). We employed multiple imputation to overcome sparse data and internally validated results using cross-validation. We used the c-index corresponding to the area under the curve as performance measure to assess the discriminative ability of prediction models.
Results
Data from 2562 CHD patients in 16 countries could be linked to 60 NUTS 2 and 121 NUTS 3 regions by postal codes. Median time between hospitalisation and interview was 14 (range 6 to 28) months. BMs included 34 patient variables, covering demographic, socioeconomic and clinical characteristics, and EMs additionally included 11 regional socioeconomic variables concerning gross domestic product, income, education, occupation, population density, and health care. For blood pressure control, BMs and EMs showed validated c-indices ranging from 0.71 to 0.73 and from 0.73 to 0.77, respectively. Analyses for cholesterol control yielded c-indices ranging from 0.69 to 0.70 in BMs and from 0.71 to 0.73 in EMs. For smoking cessation, the c-indices ranged from 0.80 to 0.84 in BMs and from 0.83 to 0.84 in EMs.
Conclusions
Prediction models based on CHD patients' individual characteristics showed a high discriminative ability regarding the control of major cardiovascular risk factors. Further consideration of large-area residential characteristics provided an additive predictive value, markedly increasing the discriminative ability of prediction models for blood pressure and cholesterol control. Socioeconomic characteristics of CHD patients' residential regions can thus help identify patients requiring more intense risk factor management.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Heart Foundation
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Affiliation(s)
- K Moerschel
- Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - D Wood
- Imperial College London, London, United Kingdom
| | - K Kotseva
- Imperial College London, London, United Kingdom
| | - J Wellmann
- Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - C Prugger
- Charite - Universitaetsmedizin Berlin, Berlin, Germany
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24
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Van De Luitgaarden I, Schrieks I, De Bacquer D, Van Oort S, Mirrakhimov E, Pogosova N, Davletov K, Dolzhenko M, Van Ballegooijen A, Kotseva K, Grobbee D, Beulens J. Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients: findings from the ESC-EORP EUROASPIRE V survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant.
Purpose
To describe patterns of alcohol consumption across different European regions and adherence to the current drinking guidelines in coronary patients with a recent CHD.
Methods
The EUROASPIRE V survey has been conducted in 2016–2017 at 131 centers in 27 European countries in 9,018 patients with a recent CHD. Median alcohol consumption, as well as the proportions abstainers and excessive drinkers (i.e. >70 grams of alcohol per week for women and >140 grams per week for men, as recommended by the European guidelines on cardiovascular prevention), were calculated for each European region (Eastern, Southern, Northern and Western Europe). To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption, as well as the participants who were incorrectly not advised were calculated per European region.
Results
Mean age was 64 years (sd=9.5), 75% was male. Abstention rates were 51% in males and 74% in females, whereas excessive drinking was reported by 10% of the males (highest in Western Europe (18%) and lowest in Eastern Europe (5%)) and 6% of the females (also highest in Western Europe (12%) and lowest in Eastern Europe (1.4%)). Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% was incorrectly not advised (Figure 1), but this percentage differed by region with 9% in Western Europe as compared to 1% in Eastern Europe. In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption.
Conclusion
In this EUROASPIRE V survey the majority of patients with a recent CHD adhere to the current drinking guidelines and only a fraction of the population was incorrectly not advised to reduce consumption. However, substantial heterogeneity exists between European regions.
Figure 1. Distribution of advice given per region
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - I Schrieks
- Julius Health Center - Julius Gezondheidscentra, Utrecht, Netherlands (The)
| | - D De Bacquer
- Ghent University, Department of Public Health and Primary Care, Ghent, Belgium
| | - S Van Oort
- Amsterdam UMC - Location VUmc, Amsterdam Cardiovascular Sciences research institute, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands (The)
| | - E Mirrakhimov
- Kyrgyz State Medical Academy, Department of Internal Medicine, Bishek, Kyrgyzstan
| | - N Pogosova
- National Medical Research Center for Cardiology, Moscow, Russian Federation
| | - K Davletov
- Kazakh National Medical University, School of Public Health, Almaty, Kazakhstan
| | - M Dolzhenko
- National Medical Academy of Postgraduate Education, Cardiology, Kiev, Ukraine
| | - A Van Ballegooijen
- Amsterdam UMC - Location VUmc, Amsterdam Cardiovascular Sciences research institute, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands (The)
| | - K Kotseva
- National University of Ireland, National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - D Grobbee
- Julius Health Center - Julius Gezondheidscentra, Utrecht, Netherlands (The)
| | - J Beulens
- Amsterdam UMC - Location VUmc, Amsterdam Cardiovascular Sciences research institute, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands (The)
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Fras Z, Jankowski P, Jug B, Gaita D, Wood D, De Bacquer D, Kotseva K. Physical activity in patients with coronary heart disease: results from the EUROASPIRE V Survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Physical inactivity is common in patients with coronary heart disease (CHD) and associated with an unfavorable prognosis. The study aim was to assess the physical activity levels as well as the intention to become physically active in patients with stable CHD with an additional focus on the association with their risk profile.
Methods
Analyses are based on the cross-sectional EUROASPIRE V survey, conducted under the auspices of the ESC EURObservational Research Project in 2016–2017. The survey encompassed 8,261 CHD patients, included in 27 countries, with a mean age of 62.4 years (±9.6, range 18 - 80 years), 25.8% of them were female. Physical activity level according to the overall patients' risk profile and their medical management was assessed, and the intention to become physically active in order to reduce their risk for recurrent events was investigated.
Results
The physical activity status found in CHD patients included was far from satisfactory in general, since only 34.4% of those interviewed were regularly physically active (for more than 30 minutes duration on average 5 times a week). Nearly half (47.3%) of the patients reported they are performing more everyday physical activity in general after the index event; while only every fifth patient (21.4%) reported to follow the specific exercise advice from a health or exercise professional, every tenth (11.3%) attending the fitness club or leisure centre, and only 6.1% joining the community walking groups. Regular exercise to increase physical fitness (defined as planned physical activity performed 3–5 times per week for 20–60 minutes) was confirmed by 34.8%, while interestingly 40.4% of patients declared regular physical activity as part of the self-reported lifestyle change in order to lose their body weight. A better cardiovascular risk profile as well as receiving physical activity advice or weight loss advice was associated with better physical activity levels.
Conclusions
Although an increase in the proportion of patients being adequately physical active after their index event, physical activity levels remain suboptimal in many CHD patients. There is an obvious need for improvement, with regards to both finding more effective ways of advice and encouraging our patients to increase the amount of their everyday exercise, as well regularly to monitor their lifestyle change.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The survey was supported through research grants to the European Society of Cardiology from Amgen, Eli Lilly, Sanofi (Gold Sponsors), Pfizer (Silver Sponsor), and Ferrer and Novo Nordisk (Bronze Sponsors).
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Affiliation(s)
- Z Fras
- University Medical Centre of Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
| | - P Jankowski
- University Hospital of Krakow, Department of Cardiology and Electrocardiology, Krakow, Poland
| | - B Jug
- University Medical Centre of Ljubljana, Div of Medicine, Vascular Medicine Dpt, Prev Cardiology Unit, Ljubljana, Slovenia
| | - D Gaita
- University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - D.A Wood
- National Institute of Preventive Cardiology, Galway, Ireland
| | - D De Bacquer
- Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - K Kotseva
- National Institute of Preventive Cardiology, Galway, Ireland
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Vynckier P, Ferrannini G, Rydén L, Tokgözoğlu L, Bruthans J, Kotseva K, Wood D, De Backer T, Gevaert S, De Bacquer D, De Smedt D. Medical Treatment in Coronary Patients: Is there Still a Gender Gap? Results from European Society of Cardiology EUROASPIRE V Registry. Cardiovasc Drugs Ther 2020; 35:801-808. [PMID: 33068226 DOI: 10.1007/s10557-020-07095-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study is aimed at investigating gender differences in the medical management of patients with coronary heart disease (CHD). METHODS Analyses were based on the ESC EORP EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) survey. Consecutive patients between 18 and 80 years, hospitalized for a coronary event, were included in the study. Information on cardiovascular medication intake at hospital discharge and at follow-up (≥ 6 months to < 2 years after hospitalization) was collected. RESULTS Data was available for 8261 patients (25.8% women). Overall, no gender differences were observed in the prescription and use of cardioprotective medication like aspirin, beta-blockers, and ACE-I/ARBs (P > 0.01) at discharge and follow-up respectively. However, a statistically significant difference was found in the use of statins at follow-up, in disfavor of women (82.8% vs. 77.7%; P < 0.001). In contrast, at follow-up, women were more likely to use diuretics (31.5% vs. 39.5%; P < 0.001) and calcium channel blockers (21.2% vs. 28.8%; P < 0.001), whereas men were more likely to use anticoagulants (8.8% vs. 7.0%; P < 0.001). Overall, no gender differences were found in total daily dose intake (P > 0.01). Furthermore, women were less likely than men to have received a CABG (20.4% vs. 13.2%; P < 0.001) or PCI (82.1% vs. 74.9%; P < 0.001) at follow-up. No gender differences were observed in prescribed (P = 0.10) and attended (P = 0.63) cardiac rehabilitation programs. CONCLUSION The EUROASPIRE V results show only limited gender differences in the medical management of CHD patients. Current findings suggest growing awareness about risk in female CHD patients.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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De Bacquer D, van de Luitgaarden IAT, De Smedt D, Vynckier P, Bruthans J, Fras Z, Jankowski P, Dolzhenko M, Kotseva K, Wood D, De Backer G. Socioeconomic characteristics of patients with coronary heart disease in relation to their cardiovascular risk profile. Heart 2020; 107:799-806. [PMID: 33067329 DOI: 10.1136/heartjnl-2020-317549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE People's socioeconomic status (SES) has a major impact on the risk of atherosclerotic cardiovascular disease (ASCVD) in primary prevention. In patients with existing ASCVD these associations are less documented. Here, we evaluate to what extent SES is still associated with patients' risk profile in secondary prevention. METHODS Based on results from a large sample of patients with coronary heart disease from the European Action on Secondary and Primary Prevention through Intervention to Reduce Events study, the relationship between SES and cardiovascular risk was examined. A SES summary score was empirically constructed from the patients' educational level, self-perceived income, living situation and perception of loneliness. RESULTS Analyses are based on observations in 8261 patients with coronary heart disease from 27 countries. Multivariate logistic regression analyses demonstrate that a low SES is associated (OR, 95% CI) with lifestyles such as smoking in men (1.63, 1.37 to 1.95), physical activity in men (1.51, 1.28 to 1.78) and women (1.77, 1.32 to 2.37) and obesity in men 1.28 (1.11 to 1.49) and women 1.65 (1.30 to 2.10). Patients with a low SES have more raised blood pressure in men (1.24, 1.07 to 1.43) and women (1.31, 1.03 to 1.67), used less statins and were less adherent to them. Cardiac rehabilitation programmes were less advised and attended by patients with a low SES. Access to statins in middle-income countries was suboptimal leaving about 80% of patients not reaching the low-density lipoprotein cholesterol target of <1.8 mmol/L. Patients' socioeconomic level was also strongly associated with markers of well-being. CONCLUSION These results illustrate the complexity of the associations between SES, well-being and secondary prevention in patients with ASCVD. They emphasise the need for integrating innovative policies in programmes of cardiac rehabilitation and secondary prevention.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Inge A T van de Luitgaarden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marina Dolzhenko
- Shupik's Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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van de Luitgaarden IAT, Schrieks IC, De Bacquer D, van Oort S, Mirrakhimov EM, Pogosova N, Davletov K, Dolzhenko M, van Ballegooijen AJ, Kotseva K, Grobbee DE, Beulens JWJ. Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients: Findings from the ESC-EORP EUROASPIRE V survey. Atherosclerosis 2020; 313:35-42. [PMID: 33011551 DOI: 10.1016/j.atherosclerosis.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/17/2020] [Accepted: 09/09/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant. We aimed to describe alcohol consumption patterns across European regions and adherence to the current guidelines in patients with a recent CHD event. METHODS The ESC-EORP survey (EUROASPIRE V) has been conducted in 2016-2017 at 131 centers in 27 European countries in 7350 patients with a recent CHD. Median alcohol consumption, as well as the proportion of abstainers and excessive drinkers (i.e. >70 g/week for women and >140 for men, as recommended by the European guidelines on cardiovascular prevention), was calculated for each region. To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption and participants who were incorrectly not advised were calculated per region. RESULTS Mean age was 64 years (SD: 9.5), 75% were male. Abstention rates were 53% in males and 77% in females, whereas excessive drinking was reported by 9% and 5% of them, respectively. Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% were incorrectly not advised, however, this percentage differed per region (range: 1%-9%). In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption. CONCLUSION In this EUROASPIRE V survey, the majority of CHD patients adhere to the current drinking guidelines, but substantial heterogeneity exists between European regions.
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Affiliation(s)
- Inge A T van de Luitgaarden
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Clinical, Zeist, the Netherlands.
| | - Ilse C Schrieks
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Clinical, Zeist, the Netherlands
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Sabine van Oort
- Amsterdam University Medical Center, Location VUmc, Amsterdam Cardiovascular Sciences Research Institute, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Erkin M Mirrakhimov
- Department of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Kairat Davletov
- Health Research Institute, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Maryna Dolzhenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Adriana J van Ballegooijen
- Amsterdam University Medical Center, Location VUmc, Amsterdam Cardiovascular Sciences Research Institute, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands; Amsterdam University Medical Center, Location VUmc, Amsterdam Cardiovascular Sciences Research Institute, Department of Nephrology, Amsterdam, the Netherlands
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; Imperial College Healthcare NHS Trust, London, UK
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Julius Clinical, Zeist, the Netherlands
| | - Joline W J Beulens
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Amsterdam University Medical Center, Location VUmc, Amsterdam Cardiovascular Sciences Research Institute, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
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Reiner Ž, De Sutter J, Ryden L, Mirrakhimov E, Pogosova N, Dolzhenko M, Fras Z, Kotseva K, Wood D, De Bacquer D. Peripheral arterial disease and intermittent claudication in coronary heart disease patients. Int J Cardiol 2020; 322:227-232. [PMID: 32918939 DOI: 10.1016/j.ijcard.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/29/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Peripheral artery disease (PAD) is associated with an increased risk of fatal and non-fatal coronary heart disease (CHD). The aims of the this study were 1) to investigate the prevalence of PAD and suspected PAD in a large population of established CHD patients, and 2) to assess the prevalence and control of risk factors in these patients as well health-related quality of life. MATERIAL AND METHODS In the EUROASPIRE V survey, 8243 patients with documented CHD were recruited from 27 ESC member countries and were invited to attend a study visit. Patients were investigated using questionnaires, in-depth interviews and a clinical examination. Intermittent claudication (IC) was assessed using the Edinburgh Claudication Questionnaire. Patients without previously diagnosed PAD were suspected of having PAD if they were found to have IC. RESULTS Overall, 6.4% of the patients had already a confirmed diagnosis of PAD and another 6.3% were suspected of having PAD. Independent of age and gender, patients with previously diagnosed PAD were significantly more frequently current smokers, had the lowest smoking cessation rates, were less physically active, reported more often previously diagnosed diabetes and had significantly higher blood pressure levels, compared to patients without PAD. They had also significantly higher levels of serum triglycerides, lower HDL-C levels, and had more often renal insufficiency. In comparison with patients without PAD, those with suspected PAD demonstrated significantly higher smoking cessation rates but their obesity rates were significantly higher. In CHD patients with a history of PAD, the use of calcium channel blockers and diuretics was significantly higher than in patients without PAD. Compared to the latter group, the use of diuretics, anti-arrhythmics and anti-depressants in patients with suspected PAD was significantly higher. Moreover, patients with previously diagnosed PAD had significantly higher levels of anxiety and depression and reported a significantly worse health-related quality of life (HRQoL), in comparison with those without PAD. HRQoL levels were significantly reduced in patients with suspected PAD as well. CONCLUSION In CHD patients without a previous diagnosis of PAD, IC is not infrequent. Diagnosed PAD was significantly associated with a worse CHD risk factor profile. Patients with known PAD as well as those with suspected PAD had a considerable loss of health-related quality of life. Therefore, physicians should consider to screen for IC in all their CHD patients.
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Affiliation(s)
- Željko Reiner
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Johan De Sutter
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium; AZ Maria Middelares Ghent, Belgium
| | - Lars Ryden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan; M.M.Mirrakhimov Kyrgyz National Centre for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Marina Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia
| | - Kornelia Kotseva
- National Heart and Lung Institute, Imperial College London, UK; National University of Ireland, Galway, Ireland
| | - David Wood
- National Heart and Lung Institute, Imperial College London, UK; National University of Ireland, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium.
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Jankowski P, Kosior DA, Sowa P, Szóstak-Janiak K, Kozieł P, Krzykwa A, Sawicka E, Haberka M, Setny M, Kamiński K, Gąsior Z, Kubica A, De Bacquer D, De Backer G, Kotseva K, Wood D, Pająk A, Czarnecka D. Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey. Cardiol J 2020; 27:533-540. [PMID: 32436589 DOI: 10.5603/cj.a2020.0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD. METHODS Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after the hospitalization. RESULTS Overall, 947 patients were examined 6-18 months after hospitalization. The proportion of patients with high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6-18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140/90 mmHg, LDL-C < 1.8 mmol/L and glucose < 7.0 mmol/L, body mass index < 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled. CONCLUSIONS The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational.
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Affiliation(s)
- Piotr Jankowski
- I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
| | - Dariusz A Kosior
- Mossakowski Medical Research Centre, Polish Academy of Science, Warsaw, Poland.,Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital the Ministry of The Interior and Administration, Warsaw, Poland
| | - Paweł Sowa
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | | | - Paweł Kozieł
- I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Krzykwa
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital the Ministry of The Interior and Administration, Warsaw, Poland
| | - Emilia Sawicka
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Haberka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Setny
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital the Ministry of The Interior and Administration, Warsaw, Poland
| | - Karol Kamiński
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Kornelia Kotseva
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London and National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
| | - David Wood
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London and National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
| | - Andrzej Pająk
- Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Danuta Czarnecka
- I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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31
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Ferrannini G, De Bacquer D, De Backer G, Kotseva K, Mellbin L, Wood D, Rydén L. Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease-A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V. Diabetes Care 2020; 43:726-733. [PMID: 32079627 DOI: 10.2337/dc19-2165] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/24/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.
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Affiliation(s)
- Giulia Ferrannini
- Department of Medical Sciences, Postgraduate School of Internal Medicine, University of Turin, Turin, Italy.,Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,European Society of Cardiology, Sophia Antipolis, France
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Republic of Ireland.,National Heart and Lung Institute, Imperial College London, London, U.K
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Pająk A, Wolfshaut-Wolak R, Doryńska A, Jankowski P, Fornal M, Grodzicki T, Jennings C, Kawecka-Jaszcz K, Kotseva K, Pająk K, Wood D. Longitudinal effects of a nurse-managed comprehensive cardiovascular disease prevention program for hospitalized coronary heart disease patients and primary care high-risk patients. Kardiol Pol 2020; 78:429-437. [PMID: 32238795 DOI: 10.33963/kp.15273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The EUROACTION study (nurse‑coordinated multidisciplinary, family‑based cardiovascular disease prevention program) documented the efficacy of a nurse‑managed, comprehensive prevention program in reducing risk factors for cardiovascular disease (CVD). No information was available on survival. AIMS The aim of the study was to assess the effects of EUROACTION intervention on CVD risk factors and 12‑year survival in the Polish component of the study. METHODS Two district hospitals and 2 primary care practices were allocated randomly to intervention (INT) or usual care (UC). The primary endpoints were lifestyle and risk factors changes at 1‑year follow‑up. Differences in survival were analyzed using the multivariable Cox proportional hazards regression models. RESULTS The study involved 628 patients with coronary heart disease (CHD) and 711 high‑risk patients. Compared to UC, INT patients achieved healthier lifestyles and a larger reduction of risk factors at 1 year but these differences were not maintained 12 years after the intervention. Less deaths occurred in patients from the INT hospital and from INT primary practice (hazard ratio [HR], 0.58; 95% CI, 0.42-0.82 and HR, 0.53; 95% CI, 0.3-0.95, respectively). Adjustment for the covariates slightly attenuated the estimates and removed significance (HR, 0.74; 95% CI, 0.52-1.04 and HR, 0.66; 95% CI, 0.36-1.24, respectively). For combined CHD and high‑risk patient groups, compared with UC, INT patients had a 36% lower risk of death after adjustment for age, sex, and history of CHD (HR, 0.64; 95% CI, 0.48-0.86). CONCLUSIONS The impact of the EUROACTION intervention on lifestyle and CVD risk factors could have contributed to lower mortality in INT coronary and high‑risk patients. These results emphasize the need for sustaining the interventions to help patients maintain a healthy lifestyle.
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Affiliation(s)
- Andrzej Pająk
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland.
| | - Renata Wolfshaut-Wolak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Doryńska
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Jankowski
- 1st Department of Cardiology and Intervention Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maria Fornal
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Catriona Jennings
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Republic of Ireland
| | - Kalina Kawecka-Jaszcz
- 1st Department of Cardiology and Intervention Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, United Kingdom; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Republic of Ireland
| | | | - David Wood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Republic of Ireland
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Jennings CS, Kotseva K, Bassett P, Adamska A, Wood D. ASPIRE-3-PREVENT: a cross-sectional survey of preventive care after a coronary event across the UK. Open Heart 2020; 7:e001196. [PMID: 32354740 PMCID: PMC7228656 DOI: 10.1136/openhrt-2019-001196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To quantify the implementation of the third Joint British Societies' Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3) after coronary event. METHODS Using a cross-sectional survey design, patients were consecutively identified in 36 specialist and district general hospitals between 6 months and 2 years, after acute coronary syndrome or revascularisation procedure and invited to a research interview. Outcomes included JBS3 lifestyle, risk factor and therapeutic management goals. Data were collected using standardised methods and instruments by trained study nurses. Blood was analysed in a central laboratory and a glucose tolerance test was performed. RESULTS 3926 eligible patients were invited to participate and 1177 (23.3% women) were interviewed (30% response). 12.5% were from black and minority ethnic groups. 45% were persistent smokers, 36% obese, 52.9% centrally obese, 52% inactive; 30% had a blood pressure >140/90 mm Hg, 54% non-high-density lipoprotein ≥2.5 mmol/L and 44.3% had new dysglycaemia. Prescribing was highest for antiplatelets (94%) and statins (85%). 81% were advised to attend cardiac rehabilitation (86% <60 years vs 79% ≥60 years; 82% men vs 77% women; 93% coronary artery bypass grafting vs 59% unstable angina), 85% attended if advised; 69% attended overall. Attenders were significantly younger (p=0.03) and women were less likely to attend (p=0.03). CONCLUSIONS Patients with coronary heart disease (CHD) are not being adequately managed after event with preventive measures. They require a structured preventive cardiology programme addressing lifestyle, risk factor management and adherence to cardioprotective medications to achieve the standards set by the British Association for Cardiovascular Prevention and Rehabilitation and JBS3 guidelines.
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Affiliation(s)
- Catriona S Jennings
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | | | - Agnieszka Adamska
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- NHLI, Imperial College London, London, UK
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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Goettler D, Wagner M, Faller H, Kotseva K, Wood D, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Factors associated with smoking cessation in patients with coronary heart disease: a cohort analysis of the German subset of EuroAspire IV survey. BMC Cardiovasc Disord 2020; 20:152. [PMID: 32228474 PMCID: PMC7106891 DOI: 10.1186/s12872-020-01429-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD. Methods The fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview. Results Out of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p = 0.002). Discussion Attending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.
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Affiliation(s)
- D Goettler
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - M Wagner
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - H Faller
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - K Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - D Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - R Leyh
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - G Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Department of Internal Medicine I, University and University Hospital of Würzburg, Würzburg, Germany
| | - W Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - P U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital of Würzburg, Würzburg, Germany
| | - S Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany. .,Department of Internal Medicine I, University and University Hospital of Würzburg, Würzburg, Germany.
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Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Cifkova R, Davletov K, Dilic M, Dolzhenko M, Gaita D, Gotcheva N, Hasan-Ali H, Jankowski P, Lionis C, Mancas S, Milićić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Vulić D, Wood D. Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries. Eur J Prev Cardiol 2020; 28:370-379. [PMID: 33966079 DOI: 10.1177/2047487320908698] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. METHODS The method used was a cross-stional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. RESULTS A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. CONCLUSION The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.
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Affiliation(s)
- Kornelia Kotseva
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Guy De Backer
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Arno Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Diederick Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Aldo Maggioni
- Maria Cecilia Hospital, GVMCare & Research Cotignola, Italy.,EURObservational Research Programme, European Society of Cardiology, France
| | | | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Portugal
| | - Carlos Aguiar
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, Czech Republic
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, Czech Republic
| | - Kairat Davletov
- Health Research Institute, Al-Farabi Kazakh National University, Kazakhstan
| | - Mirza Dilic
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Maryna Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Ukraine
| | - Dan Gaita
- Clinica de Recuperare Cardiovasculara, Universitatea de Medicina si Farmacie Victor Babes, Romania
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, Bulgaria
| | - Hosam Hasan-Ali
- Cardiovascular Medicine Department, Assiut University, Egypt
| | - Piotr Jankowski
- I Department of Cardiology, Interventional Electro-cardiology and Hypertension, Jagiellonian University Medical College, Poland
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete, Greece
| | - Silvia Mancas
- Clinica de Recuperare Cardiovasculara, Universitatea de Medicina si Farmacie Victor Babes, Romania
| | | | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Kyrgyzstan.,National Center of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Kyrgyzstan
| | - Rafael Oganov
- National Research Center for Preventive Medicine, Russia
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Ministry of Healthcare of the Russian Federation, Russia
| | - Željko Reiner
- University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - Duško Vulić
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
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Marques-Vidal P, Jankowski P, De Bacquer D, Kotseva K. Dietary measures among patients with coronary heart disease in Europe. ESC EORP Euroaspire V. Int J Cardiol 2020; 302:5-14. [PMID: 31937454 DOI: 10.1016/j.ijcard.2019.12.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess the dietary recommendations provided to patients hospitalized for a coronary heart disease (CHD) event. DESIGN Cross-sectional, multicentre observational study (ESC EORP Euroaspire V). METHODS 8261 participants (25.8% women, 9.3% aged<50 years) from 27 countries, 6 to 24 months after hospitalization for a CHD event were included. Participants were asked if they had been advised to reduce salt, fat or sugar intake, change type of fat consumed, and increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish. Self-reported changes were recorded. RESULTS Advice to reduce energy intake, salt, fat and sugar was provided to 64.5% [range: 9.2-90.5], 73.2% [38.6-95.2], 77.3% [42.3-95.6] and 67.0% [39.4-93.3] of patients, respectively. Advice to change fat type, increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish was provided to 68.3% [33.7-92.3], 36.7% [0.6-75.2], 73.2% [39.2-93.6], 66.5% [8.0-90.8] and 53.5% [3.7-83.3] of patients, respectively. Advices were more frequently provided to patients aged 50 to 69, with a high educational level, or obesity. One-eighth [0-55.0] of patients reported having consulted a dietician. Reductions in energy intake, salt, fat and sugar were reported by 57.7% [4.9-81.0], 69.9% [32.1-85.9], 71.8% [40.4-88.4] and 61.2% [29.0-84.0] of patients, respectively. Changes in fat type and increased consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish were reported by 60.9% [4.9-81.0], 25.8% [0.6-54.1], 69.2% [27.7-88.4], 54.8% [4.0-80.1] and 40.4% [2.0-66.8] of patients, respectively. CONCLUSION Dietary advice is not systematically provided to patients with CHD, and considerable differences exist between European countries.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne university hospital, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Corneel Heymanslaan 10 (4K3), B-9000 Gent, Belgium.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Republic of Ireland.
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Mitchell S, Malanda B, Damasceno A, Eckel RH, Gaita D, Kotseva K, Januzzi JL, Mensah G, Plutzky J, Prystupiuk M, Ryden L, Thierer J, Virani SS, Sperling L. A Roadmap on the Prevention of Cardiovascular Disease Among People Living With Diabetes. Glob Heart 2020; 14:215-240. [PMID: 31451236 DOI: 10.1016/j.gheart.2019.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Belma Malanda
- International Diabetes Federation, Brussels, Belgium
| | | | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes, and Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Kornelia Kotseva
- Imperial College Healthcare NHS Trust, London, United Kingdom; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - George Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jorge Plutzky
- Preventive Cardiology, Cardiovascular Medicine, Brigham and Women's Hospital, Shapiro Cardiovascular Centre, Boston, MA, USA
| | - Maksym Prystupiuk
- Department of Surgery №2, Bogomolets National Medical University, Kyiv, Ukraine
| | - Lars Ryden
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Jorge Thierer
- Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigación Clínica CEMIC, Buenos Aires, Argentina
| | - Salim S Virani
- Cardiology and Cardiovascular Research Sections, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Laurence Sperling
- Emory Heart Disease Prevention Center, Department of Global Health Rollins School of Public Health at Emory University, Atlanta, GA, USA.
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De Smedt D, De Backer T, Petrovic M, De Backer G, Wood D, Kotseva K, De Bacquer D. Chronic medication intake in patients with stable coronary heart disease across Europe: Evidence from the daily clinical practice. Results from the ESC EORP European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE IV) Registry. Int J Cardiol 2020; 300:7-13. [PMID: 31744720 DOI: 10.1016/j.ijcard.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND As advised by the European guidelines on cardiovascular prevention, medication intake is a major component of secondary prevention. The aim of this study is to provide an in-depth overview of the medication intake in stable European coronary heart disease (CHD) patients. METHODS Analyses are based on the EUROASPIRE IV survey, including CHD patients (18 to 80 years) who were hospitalized for a coronary event. These patients were interviewed and examined 6 months to 3 years after their hospitalization. Information on cardiovascular medication intake is available for 7953 patients. RESULTS About 99.2% of patients were on any kind of cardiovascular medication and 67.6% of patients were taking at least 5 different cardiovascular drugs. Overall, even when patients are taking the recommended drug combination as advised by the European guidelines - accounting for their disease profile - a large proportion of patients is still not on blood pressure, LDL-C or HbA1c target. In addition, huge variations were seen in medication dose intake across countries. Comparing the dose intake to the defined daily dose (DDD as published by the WHO) indicated a substantial deviation from the DDDs for a large proportion of patients. CONCLUSION This study provides a unique overview of the cardiovascular medication intake in CHD patients. Overall, even when patients are taking the advised drug combination, a large proportion of patients is still not on risk factor target. Physicians should seek for a balance in medication intake and appropriate dose, accounting both for the benefits and risks of chronic drug intake.
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Affiliation(s)
- Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David Wood
- National Heart & Lung Institute, Imperial College London, London, UK; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; Imperial College Healthcare NHS Trust, London, UK
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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De Smedt D, Kotseva K, De Backer G, Wood D, Van Wilder L, De Bacquer D. EQ-5D in coronary patients: what are they suffering from? Results from the ESC EORP European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE IV) Registry. Qual Life Res 2019; 29:1037-1046. [PMID: 31741215 DOI: 10.1007/s11136-019-02334-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Coronary patients often suffer from an impaired health, hence the aim of this study is to assess how coronary patients score on the different EQ-5D dimensions. METHODS Analyses are based on the EUROASPIRE IV survey, conducted across 24 European countries. 7567 patients with stable coronary heart disease (mean age = 64.1 (SD = 9.6); males = 75.8%) completed the EQ-5D-5L instrument, 6 months to 3 years after their index hospitalization. Descriptive statistics and multilevel logistic regression was used to assess the differences between patient groups in reported problems on the EQ-5D dimensions. Furthermore, age-standardized country-specific outcomes were reported. RESULTS About one out of four patients reported to have no problems on all five dimensions (57.9% reported no problems on mobility, 88.4% reported no problems on self-care, 67.1% reported no problems on usual activities, 41.1% reported no problems on pain/discomfort, and 56.2% reported no problems on anxiety/depression). Elderly patients and females reported more problems. Patients with behavioral risk factors and patients with comorbidities were more likely to have severe or extreme problems. Comparison across countries showed major differences in reported problems. CONCLUSIONS Whether or not coronary patients have problems on one or more EQ-5D dimension, as well as the severity of the problems reported is largely associated with the patient profile. The least problems are seen on the self-care dimension and most problems are reported on the pain/discomfort dimension.
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Affiliation(s)
- Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Kotseva K, De Backer G, De Bacquer D, Grobbee D, Hoes A, Jennings C, Maggioni A, Marques-Vidal P, Ryden L, Wood D. P3424Gender differences in the implementation of CVD prevention In patients with coronary disease: Results from the EUROASPIRE V Survey. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
EUROASPIRE V was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2016–2017 in 27 European countries
Purpose
To describe gender differences in lifestyle and risk factor management, and the use of cardioprotective drug therapies in patients with coronary heart disease in Europe.
Methods
Patients <80 years with coronary disease (CABG, PCI or an acute coronary syndrome) were identified from the hospital medical records and interviewed and examined by trained staff ≥6 months and ≤2 years later using standardized methods including central laboratory measurements.
Results
A total of 8,261 (25.8% females), mean age 63.6 (SD 9.6) were interviewed, with a median time between the index event and interview 1.12 years (IR 0.82–1.56). Women were older (mean age 65.4 years [SD 9.2] vs 63.0 [9.7] and had a lower level of education than men.Comparing women with men, the prevalence of the risk factors were as follows: current smoking 12.8% vs 20.7%,obesity (BMI ≥30 kg/m2) 45.7% vs 34.9%, central obesity (waist circumference ≥102 cm in men or ≥88 cm in women) 78.0% vs 51.8%, raised blood pressure (BP ≥140/90 mmHg, ≥140/80 mmHg in patients with diabetes) 47.1% vs 46.0%, elevated LDL-cholesterol (≥1.8 mmol/l) 77.9% vs 68.5% and self reported diabetes 33.1% vs 28.0%. Reported use of prophylactic drug therapies for the same comparison was: antiplatelets 91.8% vs. 92.8%; beta-blockers 81.8% vs. 80.8%; ACE inhibitors/ARBs 75.0% vs. 75.3%; and statins 76.8% vs. 82.2%. The therapeutic control of blood pressure, LDL-cholesterol and diabetes (HbA1c <7 mmol/L) was: 48.2% vs 49.9%; 25.7% vs 34.1% and 48.5% vs 56.7%, respectively.
Conclusions
The results show that women with coronary disease have higher prevalence of obesity, central obesity, elevated LDL-cholesterol and self-reported diabetes than men. There were no differences in terms of blood pressure management. All coronary patients require professional support to make lifestyle changes and manage risk factors more effectivelyin order to reduce their risk of recurrent cardiovascular events.
Acknowledgement/Funding
ESC-EORP supported by Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk
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Affiliation(s)
- K Kotseva
- Imperial College London, UK, London, United Kingdom
| | | | | | - D Grobbee
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - A Hoes
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - C Jennings
- Imperial College London, UK, London, United Kingdom
| | - A Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - P Marques-Vidal
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Ryden
- Karolinska Institute, Department of Medicine, Cardiology Unit, Stockholm, Sweden
| | - D Wood
- National Institute of Preventive Cardiology, Galway, Ireland
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Bacquer DD, Smedt DD, Reiner Ž, Tokgözoğlu L, Clays E, Kotseva K, Rydén L, Wood D, Backer GD. Percentage low-density lipoprotein-cholesterol response to a given statin dose is not fixed across the pre-treatment range: Real world evidence from clinical practice: Data from the ESC-EORP EUROASPIRE V Study. Eur J Prev Cardiol 2019; 27:1630-1636. [PMID: 31500460 DOI: 10.1177/2047487319874898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aims Recent European guidelines recommend in patients with atherosclerotic cardiovascular disease to achieve a reduction of low-density lipoprotein-cholesterol of at least 50% if the baseline low-density lipoprotein-cholesterol level is between 1.8 and 3.5 mmol/L. Systematic reviews have associated a given statin/dose combination with a fixed percentage low-density lipoprotein-cholesterol response. Algorithms for detecting cases and estimating the prevalence of familial hypercholesterolaemia often rely on such fixed percentage reductions. Methods and results We used data from 915 coronary patients participating in the EUROASPIRE V study in whom atorvastatin or rosuvastatin therapy was initiated at hospital discharge and who were still using these drugs at the same dose at a follow-up visit 6 or more months later. Pre and on-treatment low-density lipoprotein-cholesterol levels were compared across the full low-density lipoprotein-cholesterol range. The prevalence of FH was estimated using the Dutch Lipid Clinic Network criteria, once using observed pre-treatment low-density lipoprotein-cholesterol and once using imputed pre-treatment low-density lipoprotein-cholesterol by following the common strategy of applying fixed correction factors to on-treatment low-density lipoprotein-cholesterol. Inter-individual variation in the low-density lipoprotein-cholesterol response to a fixed statin and dose was considerable, with a strong inverse relation of percentage reductions to pre-treatment low-density lipoprotein-cholesterol. The percentage low-density lipoprotein-cholesterol response was markedly lower at the left end of the pre-treatment low-density lipoprotein-cholesterol range especially for levels less than 3 mmol/L. The estimated prevalence of familial hypercholesterolaemia was 2% if using observed pre-treatment low-density lipoprotein-cholesterol and 10% when using imputed low-density lipoprotein-cholesterol. Conclusion The inter-individual variation in the percentage low-density lipoprotein-cholesterol response to a given dose of a statin is largely dependent on the pre-treatment level: the lower the pre-treatment low-density lipoprotein-cholesterol level the smaller the percentage low-density lipoprotein-cholesterol reduction. The use of uniform correction factors to estimate pre-treatment low-density lipoprotein-cholesterol is not justified.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, Croatia
| | | | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
- National Heart and Lung Institute, Imperial College London, UK
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Republic of Ireland
- National Heart and Lung Institute, Imperial College London, UK
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, Belgium
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Cauter JVD, Bacquer DD, Clays E, Smedt DD, Kotseva K, Braeckman L. Return to work and associations with psychosocial well-being and health-related quality of life in coronary heart disease patients: Results from EUROASPIRE IV. Eur J Prev Cardiol 2019; 26:1386-1395. [DOI: 10.1177/2047487319843079] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary heart disease (CHD) can lead to loss of workability and early retirement. We aimed to investigate return to work (RTW) and its relationship towards psychosocial well-being and health-related quality of life (HRQoL). Design Secondary analyses were applied to cross-sectional data from the EUROASPIRE IV survey (European Action on Secondary and Primary prevention through Intervention to Reduce Events). Methods Participants were examined and interviewed at 6–36 months following the recruiting event. Psychosocial well-being and HRQoL were evaluated by completing the ‘Hospital Anxiety and Depression Scale’ and ‘HeartQoL’ questionnaire. Using generalised mixed models, we calculated the odds ratios for RTW. Depression, anxiety and adjusted means of HeartQoL were estimated accounting for RTW. Results Out of 3291 employed patients, the majority (76.0%) returned to work, of which 85.6% were men, but there was a general underrepresentation of women. Young ( p < 0.001), high-educated ( p < 0.001) patients without prior cardiovascular events ( p < 0.05) were better off regarding RTW. No significant associations with CHD risk factors and cardiac rehabilitation were established. Those that rejoined the workforce were less susceptible to psychosocial distress (anxiety/depression, p < 0.001) and experienced a better quality of life ( p < 0.001). Conclusion These findings provide evidence that non-modifiable factors (sociodemographic factors, cardiovascular history), more than classical risk factors, are associated with RTW, and that patients who resume work display better psychosocial well-being and HRQoL. Our results illustrate a need for tailored cardiac rehabilitation with a focus on work-related aspects, mental health and HRQoL indicators to reach sustainable RTW, especially in vulnerable groups like less educated and elderly patients.
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Affiliation(s)
- Joy Van de Cauter
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Lutgart Braeckman
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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Kotseva K, Gerlier L, Sidelnikov E, Kutikova L, Lamotte M, Amarenco P, Annemans L. Patient and caregiver productivity loss and indirect costs associated with cardiovascular events in Europe. Eur J Prev Cardiol 2019; 26:1150-1157. [DOI: 10.1177/2047487319834770] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | | | | | | | | | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Bichat Hospital, Paris, France
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Tiffe T, Morbach C, Malsch C, Gelbrich G, Wahl V, Wagner M, Kotseva K, Wood D, Leyh R, Ertl G, Karmann W, Störk S, Heuschmann PU. Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV. Eur J Prev Cardiol 2019; 28:1175-1183. [PMID: 37039762 DOI: 10.1177/2047487319838218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/23/2019] [Indexed: 02/02/2023]
Abstract
Abstract
Background
We assessed prevalence and determinants in appropriate physician-led lifestyle advice (PLA) in a population-based sample of individuals without cardiovascular disease (CVD) compared with a sample of CVD patients.
Methods
PLA was assessed via questionnaire in a subsample of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort free of CVD (primary prevention sample) and the German subset of the fourth EUROASPIRE survey (EUROASPIRE-IV) comprising CVD patients (secondary prevention sample). PLA was fulfilled if the participant reported having ever been told by a physician to: stop smoking (current/former smokers), reduce weight (overweight/obese participants), increase physical activity (physically inactive participants) or keep to a healthy diet (all participants). Factors associated with receiving at least 50% of the PLA were identified using logistic regression.
Results
Information on PLA was available in 665 STAAB participants (55 ± 11; 55% females) and in 536 EUROASPIRE-IV patients (67 ± 9; 18% females). Except for smoking, appropriate PLA was more frequently given in the secondary compared with the primary prevention sample. Determinants associated with appropriate PLA in primary prevention were: diabetes mellitus (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.88–10.95), hyperlipidaemia (OR 3.12; 95% CI 2.06–4.73) and hypertension (OR 1.74; 95% CI 1.15–2.62); in secondary prevention: age (OR per year 0.96; 95% CI 0.93–0.98) and diabetes mellitus (OR 2.33; 95% CI 1.20–4.54).
Conclusions
In primary prevention, PLA was mainly determined by the presence of vascular risk factors, whereas in secondary prevention the level of PLA was higher in general, but the association between CVD risk factors and PLA was less pronounced.
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Affiliation(s)
- Theresa Tiffe
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Carolin Malsch
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Valerie Wahl
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK
| | - Rainer Leyh
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Department of Cardiovascular Surgery, University Hospital Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Centre, University Hospital Würzburg, Germany
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Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan-Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stöerk S, Tokgözoğlu L, Tsioufis C, Vulic D, Wood D. 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. Eur J Prev Cardiol 2019; 26:824-835. [DOI: 10.1177/2047487318825350] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arno Hoes
- European Society of Cardiology, Sophia Antipolis, France
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Diederick Grobbee
- European Society of Cardiology, Sophia Antipolis, France
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Aldo Maggioni
- European Society of Cardiology, Sophia Antipolis, France
- ANMCO Research Centre, Florence, Italy
| | - Pedro Marques-Vidal
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Catriona Jennings
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Aguiar
- European Society of Cardiology, Sophia Antipolis, France
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular diseases, Medical Faculty, Vilnius University, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Almudena Castro Conde
- Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Renata Cifkova
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Jim Crowley
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Galway University Hospital and Croí, the West of Ireland Cardiac and Stroke Foundation, Croí Heart and Stroke Centre, Galway, Ireland
| | - Kairat Davletov
- School of Public Health, Public Health Research Centre, Kazakh National Medical University, Almaty, Kazakhstan
| | - Jaap Deckers
- European Society of Cardiology, Sophia Antipolis, France
- Erasmus MC, Rotterdam, The Netherlands
| | - Delphine De Smedt
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Johan De Sutter
- European Society of Cardiology, Sophia Antipolis, France
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium
- AZ Maria Middelares Ghent, Belgium
| | - Mirza Dilic
- European Society of Cardiology, Sophia Antipolis, France
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Marina Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Vilnis Dzerve
- European Society of Cardiology, Sophia Antipolis, France
- Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- European Society of Cardiology, Sophia Antipolis, France
- Pauls Stradins Clinical University Hospita, University of Latvia, Riga, Latvia
| | - Zlatko Fras
- European Society of Cardiology, Sophia Antipolis, France
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
| | - Dan Gaita
- European Society of Cardiology, Sophia Antipolis, France
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Nina Gotcheva
- National Heart Hospital, Dept Cardiology, Sofia, Bulgaria
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Centre, University Hospital Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
| | - Hosam Hasan-Ali
- Assiut University Heart Hospital, Cardiovascular Medicine Department, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Nebojsa Lalic
- Department for Metabolic Disorder, Intensive Treatment and Cell Therapy in Diabetes, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Seppo Lehto
- European Society of Cardiology, Sophia Antipolis, France
- Varkaus Hospital, Finland
| | - Dragan Lovic
- European Society of Cardiology, Sophia Antipolis, France
- Clinic for Internal Disease Intermedic, Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Silvia Mancas
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Linda Mellbin
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Davor Milicic
- European Society of Cardiology, Sophia Antipolis, France
- University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia
| | - Erkin Mirrakhimov
- European Society of Cardiology, Sophia Antipolis, France
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | - Rafael Oganov
- National Research Centre for Preventive Medicine, Directorate, Moscow, Russia
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Zeljko Reiner
- European Society of Cardiology, Sophia Antipolis, France
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Stefan Stöerk
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Lâle Tokgözoğlu
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Costas Tsioufis
- European Society of Cardiology, Sophia Antipolis, France
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dusko Vulic
- Centre for Medical Research, School of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
- National University of Ireland, Galway, Ireland *Listed in Supplemental Appendix
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Jennings C, Kotseva K, De Bacquer D, De Backer G, Ryden L, Grobbee D, Marques-Vidal P, Hoes A, Maggioni A, Wood D. PO407 Tobacco Addiction In Secondary Prevention: Results From Euroaspire V Coronary Patients’ Survey of CVD Prevention and Diabetes From 27 European Regions. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kotseva K, De Backer G, De Bacquer D, Grobbee D, Hoes A, Jennings C, Maggioni A, Marques-Vidal P, Rydén L, Wood D. PO469 Blood Pressure, Lipids and Diabetes Management In Patients With Coronary Heart Disease Across Europe: Results of Euroaspire V Survey. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Snaterse M, Deckers JW, Lenzen MJ, Jorstad HT, De Bacquer D, Peters RJG, Jennings C, Kotseva K, Scholte Op Reimer WJM. Smoking cessation in European patients with coronary heart disease. Results from the EUROASPIRE IV survey: A registry from the European Society of Cardiology. Int J Cardiol 2018; 258:1-6. [PMID: 29544918 DOI: 10.1016/j.ijcard.2018.01.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We investigated smoking cessation rates in coronary heart disease (CHD) patients throughout Europe; current and as compared to earlier EUROASPIRE surveys, and we studied characteristics of successful quitters. METHODS Analyses were done on 7998 patients from the EUROASPIRE-IV survey admitted for myocardial infarction, unstable angina and coronary revascularisation. Self-reported smoking status was validated by measuring carbon monoxide in exhaled air. RESULTS Thirty-one percent of the patients reported being a smoker in the month preceding hospital admission for the recruiting event, varying from 15% in centres from Finland to 57% from centres in Cyprus. Smoking rates at the interview were also highly variable, ranging from 7% to 28%. The proportion of successful quitters was relatively low in centres with a low number of pre- event smokers. Overall, successful smoking cessation was associated with increasing age (OR 1.50; 95% CI 1.09-2.06) and higher levels of education (OR 1.38; 95% CI 1.08-1.75). Successful quitters more frequently reported that they had been advised (56% vs. 47%, p < .001) and to attend (81% vs. 75%, p < .01) a cardiac rehabilitation programme. CONCLUSION Our study shows wide variation in cessation rates in a large contemporary European survey of CHD patients. Therefore, smoking cessation rates in patients with a CHD event should be interpreted in the light of pre-event smoking prevalence, and caution is needed when comparing cessation rates across Europe. Furthermore, we found that successful quitters reported more actions to make healthy lifestyle changes, including participating in a cardiac rehabilitation programme, as compared with persistent smokers.
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Affiliation(s)
- M Snaterse
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - J W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - H T Jorstad
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - D De Bacquer
- Department of Public Health, Ghent University, Belgium
| | - R J G Peters
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - C Jennings
- National Heart and Lung Institute, Imperial College, London, UK
| | - K Kotseva
- Department of Public Health, Ghent University, Belgium; National Heart and Lung Institute, Imperial College, London, UK
| | - W J M Scholte Op Reimer
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
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Affiliation(s)
- Kornelia Kotseva
- 1 National Heart and Lung Institute, Imperial College London, UK.,2 Department of Public Health, Ghent University, Belgium
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