1. on behalf of the EUROASPIRE Investigators
Risk factor management in coronary patients – results from a European wide survey
EUROASPIRE III
Professor David A Wood
on behalf of the EUROASPIRE Investigators

3. EUROASPIRE I, II and III Finland Netherlands Germany Slovenia
Czech Republic
France
Italy
Hungary

4. Participation rates Survey I : 77.2% Survey II : 76.5%
Survey III : 68.4%

5. Distribution of Age, Gender and Diagnostic Category
(%)
(years)
(%)
(%)
(%)
(%)
(%)

6. Prevalence of Smoking*
* Self-reported smoking or CO in breath > 10 ppm
S2 vs. S1 : P=0.83
S3 vs. S2 : P=0.37
S3 vs. S1 : P=0.48
P=0.64

7. Prevalence of Overweight*
* Body mass index ≥ 25 kg/m²
S2 vs. S1 : P=0.15
S3 vs. S2 : P=0.22
S3 vs. S1 : P=0.02
P=0.04

8. Prevalence of Obesity*
* Body mass index ≥ 30 kg/m²
S2 vs. S1 : P=0.009
S3 vs. S2 : P=0.051
S3 vs. S1 : P=0.0002
P=0.0006

9. Prevalence of Central Obesity*
* Waist circumference ≥ 102 cm in men or ≥ 88 cm in women
S2 vs. S1 : P=0.0001
S3 vs. S2 : P=0.47
S3 vs. S1 : P<0.0001
P<0.0001

10. Prevalence of Raised Blood Pressure (1)*
* SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg
S2 vs. S1 : P=0.83
S3 vs. S2 : P=0.51
S3 vs. S1 : P=0.65
P=0.79

11. Prevalence of Raised Blood Pressure (2)*
* SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg diabetics
S2 vs. S1 : P=0.99
S3 vs. S2 : P=0.30
S3 vs. S1 : P=0.30
P=0.49

12. Therapeutic Control of Blood Pressure*
* SBP/DBP < 140/90 mmHg for non-diabetics or < 130/80 mmHg for diabetics
S2 vs. S1 : P=0.98
S3 vs. S2 : P=0.36
S3 vs. S1 : P=0.37
P=0.57

13. Prevalence of Raised Total Cholesterol*
* Total cholesterol ≥ 4.5 mmol/L
P<0.0001
S2 vs. S1 : P<0.0001
S3 vs. S2 : P<0.0001
S3 vs. S1 : P<0.0001

14. Prevalence of Raised LDL Cholesterol*
LDL C ≥ 2.5 mmol/L for patients fasting for at least 6 hours
P<0.0001
S2 vs. S1 : P=0.001
S3 vs. S2 : P<0.0001
S3 vs. S1 : P<0.0001

15. Therapeutic Control of Total Cholesterol*
* Total cholesterol < 4.5 mmol/L
S2 vs. S1 : P<0.0001
S3 vs. S2 : P<0.0001
S3 vs. S1 : P<0.0001
P<0.0001

16. Prevalence of Diabetes*
* Self-reported history of diagnosed diabetes
S2 vs. S1 : P=0.21
S3 vs. S2 : P=0.02
S3 vs. S1 : P=0.001
P=0.004

17. Prevalence of Undiagnosed Diabetes*
* Glucose ≥ 7 mmol/L for patients fasting for at least 6 hours
S2 vs. S1 : P=0.002
S3 vs. S2 : P=0.62
S3 vs. S1 : P=0.006
P=0.005

18. Therapeutic Control of Diabetes*
* Fasting glucose < 7 mmol/L in patients with history of diabetes
S2 vs. S1 : P=0.82
S3 vs. S2 : P=0.03
S3 vs. S1 : P=0.08
P=0.04

19. Medication Use: Antiplatelets
S2 vs. S1 : P=0.29
S3 vs. S2 : P=0.0002
S3 vs. S1 : P<0.0001
P<0.0001

20. Medication Use: Beta-Blockers
S2 vs. S1 : P=0.001
S3 vs. S2 : P=0.0002
S3 vs. S1 : P<0.0001
P<0.0001

21. Medication Use: ACE Inhibitors & Angiotensin II RA
S2 vs. S1 : P<0.0001
S3 vs. S2 : P<0.0001
S3 vs. S1 : P<0.0001
P<0.0001

22. Medication Use: Statins
S2 vs. S1 : P<0.0001
S3 vs. S2 : P<0.0001
S3 vs. S1 : P<0.0001
P<0.0001

23. Medication Use: Diuretics
S2 vs. S1 : P=0.30
S3 vs. S2 : P=0.02
S3 vs. S1 : P=0.002
P=0.006

24. Conclusions from the EUROASPIRE surveys
Lifestyle of coronary patients is a major cause for concern with no change in prevalence of smoking and continuing adverse trends in prevalence of obesity and central obesity

25. Conclusions
No change in blood pressure control despite increased use of anti-hypertensive medications
61% above therapeutic target
(BP < 140/90 mmHg)
Continuing improvement in lipid control with increased use of statins
42% above the 2003 therapeutic target (TC < 4.5 mmol/l)

26. 78% above the therapeutic target of < 7.0 mmol/l
Conclusions
Increasing prevalence of diabetes, both self reported and undetected, and deteriorating therapeutic control
78% above the therapeutic target of < 7.0 mmol/l
Increased use of anti-platelets, beta- blockers, ACE/ARB’s, statins and diuretics with a lower use of CCB’s.

27. ‘A handful of pills is not enough’
Conclusions
‘A handful of pills is not enough’

28. Cardiac Rehabilitation
Standards and Core Components for Cardiac Rehabilitation
2007
Lifestyle
Education
Risk factor management
Psychosocial
Cardio-protective drug therapy
Long term management strategy

29. Cardiac Rehabilitation
Standards and Core Components for Cardiac Rehabilitation
2007
Core team
Cardiac specialist nurse
Physiotherapist
Dietician
Administrator
Designated clinical lead

30. Advise to follow cardiac rehabilitation programme*
EuroASPIRE III
Interview
All patients: 44.9%
MOR = 5.46
Men 45.9% , Women 42.0%
* Within 3 months of discharge following the index event or procedure

31. Attendance at CR programme among all patients*
EuroASPIRE III
Interview
All patients: 33.9%
MOR = 7.07
Men 34.9% , Women 31.0%
* Attending at least half of the sessions
Note: CPR attendance rate if advised to follow = 75.8%

32. 8 countries, 24 centres, 10,000+ subjects
EUROACTION
8 countries, 24 centres, 10,000+ subjects

33. Nurse coordinated multidisciplinary family based approach
The CVP&R team with Dr Martini in Boldrini Hospital, Thiene, Italy
The CVP nurse with Dr Van Nunen in Hoensbroek, The Netherlands

34. EUROACTION and EUROASPIRE III
* WC < 94 cm (men); < 84 cm (women)
**SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetics
****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with diabetes

35. EUROACTION and EUROASPIRE III
* WC < 94 cm (men); < 84 cm (women)
**SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetics
****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with diabetes

36. EUROACTION and EUROASPIRE III

37. Conclusions Annie Holden Jennifer Jones j.jones@imperial.ac.uk
Jennifer Jones

38. Management Committee Professor Ulrich Keil (Chairman)
Professor Philippe Amouyel
Professor Guy de Backer
Professor Dirk De Bacquer
Professor Alain Cohen-Solal
Professor Dan Gaita
Ms Catriona Jennings
Dr Kornelia Kotseva
Ms Malika Manini
Dr Keith McGregor
Professor Andrzej Pajak
Professor Zeljko Reiner
Professor David Wood (Principal Investigator)

39. Coordination Coordinating Centre Data Management Statistical Centre
Department of Cardiovascular Medicine
Imperial College London UK
Data Management
Euro Heart Survey Team
Sophia Antipolis, France
Statistical Centre
Department of Public Health
University of Ghent
Laboratory Centre
National Public Health Institute, Helsinki, Finland

40. Sponsors Unrestricted educational grants to the
European Society of Cardiology
AstraZeneca Bristol-Myers Squibb GlaxoSmithKline Pfizer Sanofi-Aventis Servier
Merck /Schering-Plough
Novartis