1. EURObservational Research Programme
Clinical reality of primary prevention in people at high cardiovascular risk in Europe
A comparison of EUROASPIRE III and IV surveys
in general practice
Kornelia Kotseva
National Heart and Lung Institute, Imperial College London, UK
on behalf of EUROASPIRE IV Investigators

2. Disclosure Statement of Financial Interest
Within the past 12 months, I have had a financial interest/arrangement or affiliation with the healthcare related company listed below.
European Society of Cardiology
Grant/Research Support

3. European recommendations and surveys on cardiovascular disease prevention
First Joint Task Force Recommendations
Joint European Societies Implementation Group on Coronary Prevention
1995– EUROASPIRE I
Second Joint Task Force Recommendations
1999– EUROASPIRE II
Joint European Societies CVD Prevention Committee
Third Joint Task Force Guidelines
Joint European Societies CVD Prevention Committee
2006– EUROASPIRE III
Fourth Joint Task Force Guidelines
Fifth Joint Task Force Guidelines
–15 EUROASPIRE IV – European survey of CVD
prevention and diabetes
References:
First joint task force recommendation: Pyörälä K et al. Heart J 1994;15:1300–1331
Second joint task force recommendation: Wood DA et al. Eur Heart J 1998;19:1434–1503
Third joint task force recommendation: De Backer G et al. Eur Heart J 2003;24:1601–1610
Fourth joint task force recommendation: Graham I et al. Eur Heart J 2007;28:2375–2414
Fifth joint task force recommendation: Perk J et al. Eur Heart J 2012;33:1635–1701
EUROASPIRE I and II: Wood DA et al. Lancet 2001;357:995–1001
EUROASPIRE II, III and IV: Press release from escardio.org dated entitled ‘EUROASPIRE IV: Adverse lifestyle trends counter improvements in CV risk factor management’, accessed

4. EUROASPIRE Surveys The EUROASPIRE surveys
identifies risk factors in high risk individuals
describes their management through lifestyle and use of drug therapies
providing objective assessment of clinical implementation of current knowledge

5. Objective To describe 8-year time trends
in lifestyle and risk factor management
use of cardioprotective drug therapies
In people at high cardiovascular risk
Between the EUROASPIRE III and IV surveys in general practice

6. Methods Consecutive patients, men and women <80 years
No history of coronary or other atherosclerotic
disease
Prescribed one or more of the following medications
≥6 months and ≤3 years prior to the interview
1. Blood pressure lowering and/or
2. Lipid lowering and/or
3. Glucose lowering (diet, oral drugs and/or insulin)
Interview and examination ≥6 months later

7. Data Collection Height, weight Waist circumference Blood pressure
Breath CO
Fasting venous blood sample for serum total cholesterol, HDL-cholesterol, triglycerides, glucose and HbA1c

8. Outcome Measures
Proportions of high CVD risk individuals achieving the European lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention defined in the Joint European Societies Guidelines on CVD prevention

9. EUROASPIRE III & IV Countries
Study Population
EUROASPIRE III & IV Countries
Bulgaria, Croatia, Poland, Romania, UK
Survey
Time period
Patients
Women
n (%)
Age (years) mean±SD
EUROASPIRE III
1985
1194 (60)
58±10
EUROASPIRE IV
1842
1002 (54)
59±12

10. Prevalence of smoking* at interview (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+17.2%
+3.4%
-9.0%
-8.7%
+0.0%
+0.4%
P=0.90
* Self-reported smoking or CO in breath > 10 ppm

11. No intention to quit smoking* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-0.5%
+16.1%
+8.0%
+13.3%
+2.9%
+10.6%
P=0.004
* Among current smokers

12. Prevalence of overweight* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-5.2%
-6.1%
+1.9%
+10.7%
-2.8%
-0.7%
P=0.85
* Body mass index ≥25 kg/m2

13. Prevalence of obesity* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-15.3%
+2.8%
+2.6%
+10.0%
-5.8%
-0.7%
P=0.88
* Body mass index ≥30 kg/m2

14. Prevalence of central obesity* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+4.7%
+7.7%
+11.8%
+1.5%
-1.0%
+5.8%
P=0.053
* Waist circumference ≥88/102 cm women/men

15. Obese patients ever been told by a health care professional that their diet is unhealthy (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-7.6%
+0.9%
+1.5%
-6.0%
-11.3%
-3.7%
P=0.24
* Body mass index ≥30 kg/m2

16. Obese patients ever been told by a health care professional that they are overweight (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-6.5%
-5.6%
+4.9%
-15.4%
-4.3%
-4.5%
P=0.20
* Body mass index ≥30 kg/m2

17. Obese patients actively trying to lose weight in the last month (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+6.3%
-5.4%
+4.8%
-5.6%
+13.0%
+3.6%
P=0.34
* Body mass index ≥30 kg/m2

18. Obese patients considering trying to lose weight in the next month (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+11.7%
-7.4%
+2.0%
-19.6%
+14.4%
+1.1%
P=0.86
* Body mass index ≥30 kg/m2

19. Vigorous physical activity outside work for ≥ 20 min at least three times a week (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-11.6%
+2.2%
-1.5%
+17.1%
+1.7%
+1.9%
P=0.68

20. Proportion of patients not doing regular exercise
Proportion of patients not doing regular exercise* to increase physical fitness (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-29.3%
+0.1%
-8.0%
+38.1%
-4.4%
-1.4%
P=0.91
* Regular exercise is any planned physical performed to increase physical fitness.
The activity should be performed 3-5 times/week for minutes/session.

21. Proportion of patients advised to follow a CVD prevention programme over the last 3 years (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
-0.6%
+4.5%
-6.4%
-0.9%
-6.9%
-2.1%
P=0.37

22. Therapeutic control of blood pressure* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+23.5%
+6.3%
+0.9%
+0.7%
+7.0%
+8.5%
P=0.12
* SBP/DBP <140/90 mmHg in patients using blood pressure lowering drugs
140/80 mmHg in diabetes

23. Therapeutic control of total cholesterol* ( %)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+14.8%
+19.6%
+8.1%
+20.5%
-3.5%
+9.9%
P=0.11
* Total cholesterol <4.5 mmol/L in patients using lipid lowering drugs

24. Therapeutic control of LDL-cholesterol* ( %)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+10.2%
+16.2%
+8.4%
+20.3%
-15.0%
+6.7%
P=0.38
* Total cholesterol <2.5 mmol/L in patients using lipid lowering drugs

25. Prevalence of undetected diabetes at interview* (%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+21.4%
+7.9%
+2.6%
+6.7%
+1.4%
+6.6%
P=0.09
* Fasting glucose ≥7 mmol/L in patients not reporting a history of diabetes

26. Prevalence of impaired fasting glycaemia*(%)
Bulgaria
Croatia
Poland
Romania UK
Overall P
+1.0%
-2.1%
+2.0%
-3.8%
+10.5%
+0.5%
P=0.84
* No self-reported or newly detected diabetes and
fasting glucose ≥6.1 but <7 mmol/L

27. Therapeutic control of diabetes - HbA1c <7%
Bulgaria
Croatia
Poland
Romania UK
Overall P
+3.8%
-6.6%
-6.8%
+18.6%
-3.8%
-1.2%
P=0.75

28. Conclusions Cause for concern
No change in prevalence of smoking, obesity and central obesity with more then 80% of high CVD risk patients being overweight or obese
No improvement in therapeutic control of blood pressure, LDL-cholesterol and diabetes
Large heterogeneity between countries
Call for action
There is a pressing need for modern preventive cardiology programme integrating lifestyle and medical risk factor management adapted to medical and cultural settings in each country
Urgent need of health care systems that invest in prevention

29. EUROASPIRE IV Steering Committee Executive Committee
Kornelia Kotseva (Chair Scientific Steering Committee) (UK)
Guy De Backer (Chair Executive Committee) (Belgium)
Philippe Amouyel (France)
Dirk De Bacquer (Belgium)
Stephan Gielen (Germany)
Aldo Maggioni (Italy)
Lars Ryden (Sweden)
Oliver Schnell (Germany)
Jouko Sundvall (Helsinki)
Jaakko Tuomilehto (Finland)
David Wood (Principal Investigator) (UK)
Speaker

30. EUROASPIRE IV Steering Committee National coordinators
Bulgaria: Nina Gotcheva
Croatia: Željko Reiner, Davor Milicic
Poland: Andrzej Pajak
Romania: Dan Gaita, Silvia Mancas
United Kingdom: David Wood
Speaker

31. EUROASPIRE IV Steering Committee Data management centre
Coordinating centre
Cardiovascular Medicine, International Centre for Circulatory
Health Imperial College, London, UK
David Wood Kornelia Kotseva
Catriona Jennings Agnieszka Adamska
Data management centre
EURObservational Research Programme, European Heart House, Sophia-Antipolis, France
Thierry Ferreira Myriam Glemot
Marème Konte
Statistical Centre
Department of Public Health, Ghent University, Belgium
Dirk De Bacquer
Speaker

32. EUROASPIRE IV Steering Committee Diabetes centre
Cardiology unit, Department of Medicine, Karolinska Institutet,
Stockholm Sweden
Lars Rydén Viveca Gyberg
Jaakko Tuomilehto Oliver Schnell
Central Laboratory
Laboratory of Analytical Biochemistry, National Public Health Institute
Helsinki, Finland
Jouko Sundvall Laura Lund
Speaker

33. EUROASPIRE Sponsors
The EUROASPIRE survey as an ESC initiative was supported by:
EUROASPIRE III:
AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Merck/Schering-Plough, Novartis, Pfizer, Sanofi-Aventis,
and Servier
EUROASPIRE IV
Amgen, AstraZeneca/Bristol-Myers Squibb,
F. Hoffman-La Roche, GlaxoSmithKline, and
Merck Sharp & Dohme