Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries

Background Patients with coronary heart disease (CHD) are the top priority for preventive cardiology. The first EUROASPIRE survey among patients with established CHD in nine countries in 1995-96 showed substantial potential f or risk reduction. A second survey (EUROASPIRE II) was done in 1999-2000 in the same countries to see whether preventive cardiology had improved since the first. We compared the proportion of patients in both studies who achi eved the lifestyle, risk-factor, and therapeutic goals recommended by the J oint European Societies report on coronary prevention. Methods The surveys were undertaken in the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, It aly, the Netherlands, Slovenia, and Spain. Consecutive patients (men and wo men less than or equal to 70 years of age) were identified after coronary-a rtery bypass graft or percutaneous transluminal coronary angioplasty, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. Findings 3569 and 3379 patients were interviewed in the first and second su rveys, respectively. The prevalence of smoking remained almost unchanged at 19.4% vs 20.8%. The prevalence of obesity (body-mass index greater than or equal to 30 kg/m(2)) increased substantially from 25.3% to 32.8%. The prop ortion with high blood pressure (greater than or equal to 140/90 mm Hg) was virtually the same (55.4% vs 53.9%), whereas the prevalence of high total cholesterol concentrations (greater than or equal to5.0 mmol/L) decreased s ubstantially from 86.2% to 58.8%. Aspirin or other antiplatelet therapy was as widely used in the second survey as the first (83.9% overall), and repo rted use of beta -blockers, angiotensin-converting-enzyme inhibitors, and e specially lipid-lowering drugs increased. Interpretation The adverse lifestyle trends among European CHD patients are a cause for concern, as is the lack of any improvement in blood-pressure m anagement, and the fact that most CHD patients are still not achieving the cholesterol goal of less than 5 mmol/L. There is a collective failure of me dical practice in Europe to achieve the substantial potential among patient s with CHD to reduce the risk of recurrent disease and death.