Amsterdam, The Netherlands –Tuesday 3 September 2013: Adverse lifestyle trends are countering improvements in cardiovascular risk factor management in coronary patients, according to results from three EUROASPIRE surveys in 1999-2013. The EUROASPIRE time trend analysis was presented today at ESC Congress 2013.
The EUROASPIRE1 surveys describe lifestyle, risk factor control and cardioprotective drug management of coronary patients in Europe. Standardised methodologies have been used in each survey which allow for comparisons over time.
A time trend analysis was conducted in the nine countries (Belgium, Czech Republic, Finland, France, Ireland, the Netherlands, Poland, Slovenia, the UK) which conducted surveys II (1999-2000), III (2006-07) and IV (2012-13). A total of 12,775 consecutive patients <70 years with coronary artery disease (coronary artery bypass surgery, angioplasty or acute coronary syndromes) were included of whom 8,456 were interviewed across the three surveys ≥6 months after their initial hospitalisation.
Smoking prevalence stayed the same (21% in 1999/2000, 19.9% in 2006/7, 18.2% in 2012/13; p=0.55) and remained highest in patients <50 years. Dr Kornelia Kotseva (UK) said: “The highest levels of smoking are still in the youngest patients who have the most to gain from quitting. But the use of pharmacotherapy for smoking cessation remained low over the 14 years so more emphasis is needed in this area.”
The prevalence of obesity increased across the three surveys (31.9%, 33.3%, 38.5%; p=0.007) as did the prevalence of central obesity (50.5%, 50.5%, 57.2%; p=0.04). Average body mass index (BMI, kg/m2) increased from 28.5 (standard deviation [SD]=4.5) to 28.8 (SD=4.6) and to 29.2 (SD=4.7) kg/m² across the three surveys. Physical activity did not change over the 14 year study period.
The prevalence of diabetes increased across the three surveys (18.5%, 23.8%, 27.2%; p=0.0004). Glycaemic control in patients with diabetes remained unchanged, with only 30% of patients achieving the therapeutic threshold for fasting glucose (<7 mmol/L).
Dr Kotseva said: “Lifestyle trends are moving in the wrong direction. The prevalence of obesity and central obesity has increased over the three surveys and is now at its highest level. And there is a corresponding increase in the prevalence of diabetes.”
The use of cardioprotective drugs increased between surveys II and III, but there was no significant change between surveys III and IV. Dr Kotseva said: “We seem to have hit a ceiling on the use of cardioprotective medications. Most patients use optimal drug treatment but do not benefit fully because of their poor lifestyle.”
The prevalence of raised blood pressure dropped by 8% from survey III to IV, while the prevalence of very high blood pressure (systolic ≥160 mmHg and/or diastolic ≥100 mmHg) dropped significantly across the three surveys (21.9%, 16.8% and 12.8%; p=0.0006). Therapeutic control of blood pressure in patients using blood pressure lowering drugs improved significantly with 55% of patients below target in survey III.
The prevalence of raised total cholesterol (≥4.5 mmol/l) decreased (77.0%, 40.6%, 32.8%; p<0.0001) as did the prevalence of elevated LDL cholesterol (≥2.5 mmol/l) (78.0%, 42.9%, 33.5%; p<0.0001). The proportion of patients on lipid-lowering drugs who met the LDL cholesterol target (<1.8 mmol/L) increased even though use of these drugs stabilised between surveys II and III. However, 75.3% of patients still did not reach the target.
Professor Wood said: “Management of blood pressure and lipids has improved but again the benefits are mitigated by poor lifestyle and a growth in obesity and diabetes. Our analysis highlights the pressing need for modern preventive cardiology programmes with lifestyle change at their core and not simply writing prescriptions for drugs.”
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