SHA24/035002

EUROASPIRE European surveys of CVD prevention and diabetes Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London UK

EUROASPIRE SURVEYS European Action on Secondary and Primary Prevention of Cardiovascular Disease In Order to Reduce Events European Society of Cardiology EuroObsevational Research Programme

EUROASPIRE surveys Methodology Cross sectional surveys Retrospective identification of consecutive patients Interview and examination using standardised instruments including a central laboratory for lipids and glucose

EUROASPIRE I, II and III

Finland Netherlands

Slovenia

Germany

Czech Republic France

Italy

Hungary

K Kotseva, et al Lancet 2009; 373; 929-940

EUROASPIRE surveys

Time trends

Prevalence of smoking, obesity* and central obesity** *Body mass index ≥ 30 kg/m² **Waist circumference ≥ 88 cm for women and ≥ 102 cm for men 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Smoking

Obesity

Central obesity

Survey 1

20.3%

25.0%

42.2%

Survey 2

21.2%

32.6%

53.0%

Survey 3

18.2%

38.0%

54.9%

in Prevalence prevalence smoking in and gender EUROASPIRETrends I, II and III: of of smoking by age EUROASPIRE I, II and III surveys

Prevalence of raised blood pressure*, elevated TC** and LDL-C***, and self-reported diabetes mellitus *SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg diabetics ** TC ≥4.5 mmol/l; *** LDL-C ≥4.5 mmol/l 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Raised BP

Elevated TC

Elevated LDL-C

Diabetes

Survey 1

58.1%

94.5%

96.4%

17.4%

Survey 2

58.3%

76.7%

78.1%

20.1%

Survey 3

60.9%

46.2%

47.5%

28.0%

Cardiovascular Protective Drug Therapies

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Antiplatelets

Beta-blockers

ACE/ARB's

Statins

Survey 1

80.8%

56.0%

31.0%

18.1%

Survey 2

83.6%

69.0%

49.2%

57.3%

Survey 3

93.2%

85.5%

74.5%

87.0%

EUROASPIRE III Hospital 8966 coronary patients from 22 countries

Netherlands

Finland Russia

Ireland Latvia

UK

Lithuania

Germany Czech Republic France Croatia

Poland Hungary

Belgium Slovenia

Romania Bulgaria Greece

Spain Italy

Turkey Cyprus

K Kotseva Eur J Cardiovasc Prev Rehab 2009; 16:121-37

EUROASPIRE III Study Populations

Coronary patients in hospital: •CABG/PTCA; •ACS (STEMI/NSTEMI); •Myocardial ischaemia

EUROASPIRE surveys

Audit of medical record keeping

Available information in medical records: Risk factor levels

EuroASPIRE

Medical records

100%

Admission

Discharge 92% 87%

90% 80% 70%

66% 62%

63%

63%

Systolic BP

Heart rate

60% 50% 41%

40%

40% 30% 20%

14%

13%

10% 0% Height

Weight

Waist circumference

EuroASPIRE

Available information in medical records: Risk factor levels Medical records

100%

Admission

Discharge

90% 80%

80% 75% 67%

70% 60%

54%

57%

58%

56% 48%

50% 41%

41%

40% 30% 20%

15%

10%

11%

6% 4%

0% TC

HDL

Triglycerides

LDL

Glucose

HbA1c

HbA1c in diabetics

EUROASPIRE surveys

Assessment of patient management through standardised interviews and examinations

Advise to follow cardiac prevention or rehabilitation programme*

EuroASPIRE III

Interview

90.3%

Lithuania Ireland Belgium

88.0% 77.8% 71.3%

Bulgaria Slovenia Germany Hungary The Netherlands

60.5% 57.8% 56.6% 54.6% 53.4%

Poland Italy Czech Republic United Kingdom Croatia Finland

51.5% 50.0% 43.0% 41.9% 40.2% 37.7%

Latvia France Romania Russian Federation Turkey

32.4% 26.4%

All patients: 44.9%

8.2%

MOR = 5.46 Men 45.9% , Women 42.0%

7.3%

4.9% Cyprus Greece 0.8% Spain 0.6% 0%

10%

20%

30%

40%

50%

* Within 3 months of discharge following the index event or procedure

60%

70%

80%

90%

100%

Proportion of patients advised to follow a CRP by diagnotic category

100 90 80

75

70

%

60 50

40

40

41 30

30 20 10 0

CABG

PTCA

AMI

Ischaemia

Prevalence of CVD risk factors according to participation in a CRP 70

50

%

57

54 47

40 30

p=0.14

P=0.0008

60

p<0.0001

p=0.004 No CRP

56 49

p=0.83 35

CRP

53

35

20 10

15

19

0 Smoking

Smoking*

Obesity

Raised BP**

Elevated TC***

•*Among patients smoking prior to the index event • **BP ≥ 140/90 mmHg, (≥ 130/80 mmHg in patients with diabetes);*** TC ≥ 4.5 mmol/L

EUROASPIRE III PRIMARY CARE 4366 high risk patients from 12 countries Finland Netherlands

Slovenia

Germany

Czech Republic France

Italy

Hungary

K Kotseva Eur J Cardiovasc Prev Rehab 2010; 16:121-37

EUROASPIRE III Study Populations

Individuals at high risk of developing cardiovascular disease in primary care: •Hypertension •Dyslipidaemia •Diabetes

EUROASPIRE surveys

Patient attitudes, knowledge and skills

EuroASPIRE III

â&#x20AC;&#x153;Are you worried that you may develop heart disease?â&#x20AC;?

Interview

Germany

46

Belgium

8 55

UK

8

46

24

79

Italy

11

59

Poland 58

Finland

58

Romania

10 14

8

34

8

35

7

79

16

21

5

75

Spain

5

76

Latvia

21

78 10%

11

31 78

Slovenia

0%

37 30

Croatia

Bulgaria

47

20%

30%

40%

Agree All patients:

63.2%

3 21

50%

Neutral 26.1%

60%

70%

Disagree 10.7%

80%

90%

1 100%

â&#x20AC;&#x153;What you think your risk of heart disease is in next 10 years?â&#x20AC;?

EuroASPIRE III

Interview

Finland

16

38

Latvia 1

51

Croatia

49

30

23

Germany

49

18

Spain

25

41

24

28

UK

46

16

Romania

23

41

23

19

Poland

25

47

20

Belgium

49

11

22

58

6

20

49

Italy 0%

37

12

Slovenia

Bulgaria

44

14

28 10%

39 20%

30%

Low All patients:

16.4%

40%

Moderate 45.6%

12 50%

60%

70%

High

Don't know

24.8%

13.2%

80%

90%

100%

EuroASPIRE III

â&#x20AC;&#x153;Do you think your risk is higher, lower, or about the same as a person of the same age and sex as you?â&#x20AC;?

Interview

Italy 1

39

Finland Latvia

20

Germany

13

37

52

10

36

55

12

35 54

18

Poland

17

Slovenia

34 50

33

53

30

33

41

14

27

66

Bulgaria 0%

46 50

UK

Romania

50

45 13

Spain

30

9

Croatia

Belgium

61

21

52 10%

20%

33 30%

40%

Lower All patients:

16.2%

50%

Same 46.8%

60%

70%

Higher 36.9%

15 80%

90%

100%

EUROASPIRE surveys

Comparisons of secondary and primary prevention

EUROASPIRE III A comparison of coronary and high risk patients 100%

* WC < 94 cm (men); < 84 cm (women)

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Smoking

BMI > 30 kg/m2

Abdo obesity*

Coronary

46.5%

35.5%

52.0%

High Risk

83.6%

43.5%

61.6%

Column 3

EUROASPIRE III A comparison of coronary and high risk patients **SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetes ****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with self reported diabetes 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

BP>140/90mmHg**

TC>4.5 mmol/l

LDL-C>2.5 mmol/l

Diabetes***

Glucose >6.1mmol/l

Coronary

54.0%

44.0%

44%

25%

90%

High risk

71.0%

79.0%

81%

43%

91%

Column 3

EUROASPIRE III A comparison of coronary and high risk patients

Cardioprotective drug therapies 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Anti-platelets

B-blockers

ACE/ARB's

Ca antagonists

Statins

Coronary

90.5%

79.8%

71%

25%

78%

High risk

22.0%

31.1%

56%

24%

40%

Column 3

EUROASPIRE surveys

Health economics

EUROASPIRE surveys

Health economics

EUROASPIRE surveys

Prevention is cost effective!

EUROASPIRE surveys

Prevention is cost effective but it deprives us of business!

National Coordinators Giovanni Ambrosio Philippe Amouyel Steering Committee Dennis Cokkinos (3) Guy De Backer Jaap Deckers II. National Coordinators Vilnis Dzerve Zlatko Fras Dan Gaita Nina Gotcheva Ian Graham Ulrich Keil

Aleksandras Laucevicius Seppo Lehto Pambis Nicolaides Rafael Oganov Erika Ostör Andrzej Pajak Zeljko Reiner Jaroslav Simon Lâle Tokgözoğlu Jose De Velasco Kornelia Kotseva