A EUROPEAN-SOCIETY OF CARDIOLOGY SURVEY OF SECONDARY PREVENTION OF CORONARY HEART-DISEASE - PRINCIPAL RESULTS

Background The three major European scientific societies in cardiovasc ular medicine - the European Society of Cardiology (ESC), the European Atherosclerosis Society and the European Society of Hypertension - pu blished in October 1994 joint recommendations on prevention of coronar y heart disease in clinical practice, Patients with established corona ry heart disease, or other major atherosclerotic disease, were deemed to be the top priority for prevention. A European survey (EUROASPIRE) was therefore conducted under the auspices of the ESC to describe curr ent clinical practice in relation to secondary prevention of coronary heart disease. Aims The aims of EUROASPIRE were (i) to determine wheth er the major risk factors for coronary heart disease are recorded in p atients medical records; (ii) to measure the modifiable risk factors a nd describe their current management following hospitalization, and (i i) to determine whether first degree blood relatives have been screene d. Methods The survey was conducted in selected geographical areas and hospitals in nine European countries. Consecutive patients(less than or equal to 70 years) were identified retrospectively with the followi ng diagnoses: coronary artery bypass grafting, percutaneous translumin al coronary angioplasty, acute myocardial infarction and acute myocard ial ischaemia without infarction. Data collection was based on a retro spective review of hospital medical records and a prospective intervie w and examination of the patients. Results 4863 medical records were r eviewed of whom 25% were women, and 3569 patients were interviewed (ad justed response rate 85%) with an average age of 61 years. Nineteen pe rcent of patients smoked cigarettes, 25% were overweight (BMI greater than or equal to 30kg.m(-2)), 53% had raised blood pressure (systolic BP greater than or equal to 140 and/or diastolic BP greater than or eq ual to 90 mmHg), 44% had raised total plasma cholesterol (total choles terol greater than or equal to 5.5 mmol.1(-1)) and 18% were diabetic. Reported medication al interview was: antiplatelet drugs 81%, beta-blo ckers, 54% (58% in post-infarction patients). ACE inhibitors 30% (38% in post infarction patients) and lipid lowering drugs 32%. Of the pati ents receiving blood pressure lowering drugs (not always prescribed fo r the treatment of hypertension) 50% had a systolic BP >140 mmHg and 2 1% >160 mmHg, and of those receiving lipid lowering drugs, 49% had pla sma total cholesterol >5.5 mmol.1(-1) and 13% >65 mmol.1(-1) Thirty-se ven percent of patients had a family history of premature coronary hea rt disease in a first-degree blood relative, but only 21% of patients reported being advised to have their relatives screened for coronary r isk factors. Conclusions This European survey has demonstrated a high prevalence of modifiable risk factors in coronary heart disease patien ts. There is considerable potential for cardiologists and physicians t o further reduce coronary heart disease morbidity and mortality and im prove patients chances of survival.