Euroaspire II -European Action on Secondary and Primary ... · FRA/LLRT France - Lille, Lomme,...

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EUROASPIRE II

European Action on Secondary and PrimaryPrevention through Intervention

to Reduce Events

Euro Heart Survey ProgrammeEuropean Society of Cardiology-ESC

European Society of Cardiology ESC

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Priorities of Coronary Heart Disease Prevention in Clinical Practice

1. Patients with established CHD or other atherosclerotic disease

2. Healthy individuals who are at high risk of developing CHD or other atherosclerotic disease, because of risk factors -including smoking, raised blood pressure, lipids (raised total cholesterol and LDL-cholesterol, low HDL-cholesterol and raised triglycerides) raised blood glucose, family history of premature coronary disease - or who have severe hypercholesterolaemia, or other forms of dyslipidaemia, hypertension or diabetes

3. Close relatives ofpatients with early-onset CHD or atherosclerotic disease healthy individuals at particularly high risk

4. Other individuals met in connection with ordinary clinical practice


EUROASPIRE

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To be achieved by changes in lifestyle To be achieved by changes in lifestyle and, if needed, by drug treatmentand, if needed, by drug treatment

Goals for primary and secondary prevention of CHD (1)

Lifestyle* Stop smoking* Make healthy food choices* Be physically active

Other risk factors

* Blood pressure < 140/90 mmHg* Total cholesterol < 5.0 mmol/l (190 mg/dl)* LDL cholesterol < 3.0 mmol/l (115 mg/dl)* Good glucose control in diabetes


EUROASPIRE

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Goals for secondary and primary prevention of CHD (2)

Other prophylactic drug therapiesSecondary prevention :!Secondary Prevention - Aspirin in virtually all patients

- Beta-blockers after myocardial infarction- ACE inhibitors in patients with heart

failure/LV dysfunction- Anticoagulants in patients at high risk

of thromboembolic events

! Primary prevention Aspirin (75 mg) in treated hypertensive

patients and in men at particularly high CHDriskprevention :


EUROASPIRE

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Goals for primary and secondary prevention of CHD (3)

Screen close relatives of

* Patients with premature CHD(men < 55 yr and women < 65 yr)

* Patients with suspected familialdyslipidaemias


EUROASPIRE

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Principal Scientific Objective

EUROASPIRE II

EUROASPIRE

To determine in patients with CHD whether the major risk factors for recurrent CHD are being effectively managed by lifestyle and, when appropriate,drug therapy


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EUROASPIRE IIEUROASPIRE

Patients hospitalised because of

1) First elective or emergency CABG2) First elective or emergency PTCA,

no previous CABG3) AMI, no previous CABG or PTCA4) Acute myocardial ischaemia,

no previous CABG, PTCA or AMI

Study population


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Study population

EUROASPIRE II

EUROASPIRE

# Consecutive patients, aged < 71 yrs, hospitalised in the period from 1st January 1997 to at least 6 months prior to the interview

# Interviews: September 1999 - February 2000

# Median time between index event and interview:1.44 yrs (interquartile range 0.96 -1.95 yrs)


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Participating centres


BEL/GHE Belgium - GhentCZE/PP Czech Republic - Pilsen, PragueFIN/KUO Finland - KuopioFRA/LLRT France - Lille, Lomme, RoubaixGER/MUNS Germany - MünsterGRE/ATCI Greece - Athens, Thessaloniki, Crete, IoanninaHUN/BUD Hungary - BudapestIRE/DUB Ireland - DublinITA/TV Italy - Treviso, VeronaNET/ROT the Netherlands - RotterdamPOL/CRA Poland - CracowSLO/LJU Slovenia - LjubljanaSPA/BAR Spain - BarcelonaSWE/MAL Sweden - MalmöUK/HL United Kingdom - Hull, London


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260

410

348

365

402

391

389

345

258

357

427

446

404

392

362

0 100 200 300 400 500 600 700 800

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

by centerTotal = 5,556 patients

Number of interviewed patients

EUROASPIRE


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% smoking* at interviewby center

EUROASPIRE

23

19

22

24

17

25

30

26

15

28

18

15

18

21

18

21

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL

* self-reported and/or CO in breath > 10 ppm European Society of Cardiology ESC

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Distribution of BMI at interviewby center

EUROASPIRE

27

40

34

38

31

28

37

27

24

28

28

34

27

38

31

52

47

45

42

52

51

42

49

51

51

51

51

47

44

48

27

48

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL

30 kg/m² 25-30 kg/m²≥≥≥≥


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% raised blood pressure* at interviewby center

EUROASPIRE

4442

5055

6348

3748

4952

4862

4362

5251

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL

* systolic BP ≥≥≥≥ 140 mmHg and/or diastolic BP ≥≥≥≥ 90 mmHg European Society of Cardiology ESC

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% reaching goal* at interview among those using BP lowering medication

by center

EUROASPIRE

5557

5044

3652

635150

4952

3855

364949

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL

* systolic BP < 140 mmHg and diastolic BP < 90 mmHg

Therapeutic control of blood pressure at interview


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% total cholesterol ≥≥≥≥ 5 mmol/l at interviewby centerEUROASPIRE

77

73

43

60

66

65

60

54

57

44

64

68

53

40

54

58

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% reaching goal* at interview among those using lipid-lowering medication

by center

EUROASPIRE

3931

7044

4142

4855

4966

4941

5265

5451

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL

* total cholesterol < 5 mmol/l

Therapeutic control of total cholesterol at interview


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% self-reported diabetes at interviewby centerEUROASPIRE

1422

1928

142121

922

1315

2435

1421

200 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% aspirin/other anti-platelets at interview

by centerEUROASPIRE

9088

828686

9275

9392

8187

8286

9281

86

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% beta-blockers at interviewby center

EUROASPIRE

7774

8860

6855

8447

6148

6266

4764

4463

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% ACE inhibitors at interviewby center

EUROASPIRE

3047

24

39

45

32

57

27

52

38

48

59

22

19

27

38

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% lipid-lowering drugs at interviewby center

EUROASPIRE

4957

646868

4751

6260

7642

5865

7769

61

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% statins at interviewby centerEUROASPIRE

4339

6361

3145

6157

7535

5660

7468

55

66

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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% anti-coagulants at interviewby centerEUROASPIRE

3

4

11

3

5

4

11

4

1

16

6

9

6

9

4

7

0 20 40 60 80 100

BEL/GHE

CZE/PP

FIN/KUO

FRA/LLRT

GER/MUNS

GRE/ATCI

HUN/BUD

IRE/DUB

ITA/TV

NET/ROT

POL/CRA

SLO/LJU

SPA/BAR

SWE/MAL

UK/HL

ALL


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Conclusions


! A high prevalence of unhealthy lifestyles, modifiable risk factors and inadequate use of prophylactic drug therapies is found in coronary patients across Europe

! Considerable potential to raise the standard of preventive cardiology exists throughout Europe in order to reduce coronary morbidity and mortality


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EUROASPIRE IISteering GroupEUROASPIRE

Pr Guy De Backer, Chairperson

Pr Giovanni B AmbrosioPr Philippe AmouyelPr Dennis Cokkinos Pr Jaap DeckersPr Leif ErhardtPr Ian GrahamPr Irena KeberPr Ulrich Keil

Dr Seppo LehtoDr Erika Ostör

Pr Andrzej PajakPr Kalevi PyöräläDr Susana Sans

Pr Jaroslav SimonPr David Wood, Coordinator


Euroaspire II -European Action on Secondary and Primary ... · FRA/LLRT France - Lille, Lomme,...

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