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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
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.
• Grant/Research
Support
• European Society of
Cardiology
European recommendations and surveys on
cardiovascular disease prevention
1994
First Joint Task Force Recommendations
1994
Joint European Societies Implementation Group
on Coronary Prevention
1995–96
EUROASPIRE I
1998
Second Joint Task Force Recommendations
1999–2000
EUROASPIRE II
2000
Joint European Societies CVD Prevention Committee
2003
Third Joint Task Force Guidelines
2006–2007
EUROASPIRE III
2007
Fourth Joint Task Force Guidelines
2012
Fifth Joint Task Force Guidelines
2013
Joint European Societies CVD Prevention Committee
–15
EUROASPIRE IV – European survey of CVD
prevention and diabetes
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
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
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
Data Collection
•
•
•
•
•
Height, weight
Waist circumference
Blood pressure
Breath CO
Fasting venous blood sample for serum total
cholesterol, HDL-cholesterol, triglycerides,
glucose and HbA1c
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
Study Population
EUROASPIRE III & IV Countries
Bulgaria, Croatia, Poland, Romania, UK
Survey
Time
period
Patients
Women
n (%)
Age (years)
mean±SD
EUROASPIRE III
EUROASPIRE IV
2007-2008
2014-2015
1985
1842
1194 (60)
1002 (54)
58±10
59±12
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
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
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
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
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
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
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
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
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
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
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 20-60 minutes/session.
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
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
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
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
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
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
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
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, LDLcholesterol 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
EURObservational Research Programme
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
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
EURObservational Research Programme
EUROASPIRE IV Steering Committee
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
EURObservational Research Programme
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
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