Clinical reality of coronary prevention in Europe : A comparison

Dr Kornelia Kotseva, Consultant Cardiologist and the Project Manager for the EUROASPIRE III survey commented "despite the increase in prophylactic drug therapy, the majority of coronary patients in Europe have still not achieved the blood pressure target and two out of five are not achieving the total cholesterol goal".

Medical treatment by cardiologists in coronary patients is not sufficient. Drug therapy without addressing the underlying causes of the disease can never achieve the overall benefits of prevention. Drug therapy should always go hand in hand with a professional lifestyle intervention.

Summary

So these three surveys of coronary patients, uniquely spanning 12 years of European clinical practice, show that lifestyle management is a growing cause for concern. No change in the prevalence of smoking, and alarming increases in both obesity and central obesity. These lifestyle trends are adversely impacting the management of other major risk factors for recurrent coronary disease, stroke, kidney and heart failure. Blood pressure management remains unchanged, despite a substantial increase in the use of anti-hypertensive medications. Only a third of patients on drugs are being therapeutically controlled to target. Lipid management shows enormous improvement, almost entirely due to the widespread use of statins. However, a substantial proportion of patients still remain above the recommended lipid targets. The challenge of achieving these targets will be even greater with the new lower total and LDL-cholesterol targets being announced at the 2007 ESC Congress. The rising prevalence of diabetes is a growing concern, with almost half of all coronary patients with this diagnosis, about a third of who are undetected. Therapeutic management of diabetes remains poor and consequently there is an increased risk of both recurrent coronary disease and stroke, and also microvascular complications. The use of cardioprotective medications has increased across all classes, with the exception of CCB”s, and the greatest increase is seen for statins. Yet it is clear from these time trends that drug therapies are simply not sufficient and need to be combined with a professional lifestyle and risk factor intervention.

Professor David Wood, the Principal Investigator for the EUROASPIRE surveys said «patients need professional support to make lifestyle changes and also manage their risk factors more effectively. Simply giving a prescription is not enough. Patients need to understand the nature of their disease and how to mange it through lifestyle and drugs. This can only be achieved by a comprehensive prevention and rehabilitation programme.”

In EUROASPIRE III only one third of patients accessed any form of cardiac rehabilitation in Europe because, despite compelling scientific evidence that such programmes reduce total mortality, there is completely inadequate provision in many countries. All coronary patients are entitled to a comprehensive ambulatory multidisciplinary cardiovascular prevention and rehabilitation programme to help them reduce their risk of recurrent disease and improve their quality of life and life expectancy. With continuing adverse lifestyle trends coupled with inadequate risk factor management there is a compelling need for “Prevention Centres” providing a full range of preventive cardiology services.

Professor Hugo Saner, President of the European Association for Cardiovascular Prevention and Rehabilitation commented “Although most European Hospitals could provide services for prevention and rehabilitation, coordinated lifestyle intervention programmes are rarely offered. There is an urgent need to offer secondary prevention programmes through comprehensive cardiac rehabilitation to all patients with established cardiovascular disease, and also to those at high risk of developing the disease. The European Association for Cardiovascular Prevention and Rehabilitation has taken the initiative to promote the establishment of effective and comprehensive “Prevention Centres” in most European Hospitals within the next few years”.

Reference:

This study was presented at the ESC Annual Congress in Vienna.

Notes:

Declaration of interest: The European Society of Cardiology received unrestricted educational grants from the following pharmaceutical companies to support the costs of this survey: AstraZeneca, Bristol-Myers Squibb, Glaxo Smith Kline, Merck/Schering-Plough, Novartis, Pfizer, Sanofi-Aventis, Servier.

The European Society of Cardiology (ESC):

The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.

The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies.