Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries.

BACKGROUND: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. METHODS: The method used was a cross-stional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. RESULTS: A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. CONCLUSION: The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.

Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry.

AIMS: The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. DESIGN: A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. METHODS: Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. RESULTS: A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. CONCLUSION: A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.

Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions.

Background European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV in primary care was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2014-2015 in 71 centres from 14 European countries. The main objective was to determine whether the 2012 Joint European Societies' guidelines on cardiovascular disease (CVD) prevention in people at high CVD risk have been followed in clinical practice. Methods Patients without a history of atherosclerotic disease started on either blood pressure and/or lipid and/or glucose-lowering treatments were identified and interviewed at least six months after the start of medication. Results Medical notes of 6700 patients were reviewed, and 4579 patients (58.7% women; mean age 58.8 (standard deviation (SD) 11.3) years) interviewed (interview rate 68.3%). Overall, 16.6% were smokers, 39.9% were overweight (body mass index (BMI)≥25 and <30 kg/m2), 43.5% obese (BMI ≥30 kg/m2) and 63.9% centrally obese (waist circumference of ≥88 cm for women, ≥102 cm for men). The medical risk factor control was very poor, with less than half (42.8%) of the patients on blood pressure lowering medication reaching the target of <140/90 mm Hg (<140/80 mm Hg in people with self-reported diabetes). Among treated dyslipidaemic patients only 32.7% attained the low-density lipoprotein (LDL)-cholesterol target of <2.5 mmol/l. Among people treated for type 2 diabetes mellitus, 58.5% achieved the glycated haemoglobin (HbA1c) target of <7.0%. Conclusion The EUROASPIRE IV survey shows that large proportions of patients at high CVD risk have unhealthy lifestyle habits and uncontrolled blood pressure, lipids and diabetes. The present data make it clear that more efforts must be taken to improve cardiovascular prevention in people at high CVD risk.

Lifestyle and risk factor management in people at high cardiovascular risk from Bulgaria, Croatia, Poland, Romania and the United Kingdom who participated in both the EUROASPIRE III and IV primary care surveys.

OBJECTIVE: The objective of this study was to determine time trends in the implementation of European guidelines on the management of cardiovascular disease prevention in people at high cardiovascular risk. METHODS: Cardiovascular disease prevention as reflected in the primary care arms of the EUROASPIRE III and IV surveys were compared in centres from Bulgaria, Croatia, Poland, Romania and the United Kingdom that participated in both surveys. All patients were free of cardiovascular disease but considered at high cardiovascular disease risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy. RESULTS: EUROASPIRE III comprised 2604 and EUROASPIRE IV 3286 subjects whereof 76% and 56% were interviewed. There were no major differences between the two surveys in age, gender, centres and reasons for inclusion. The prevalence of smoking was similar between EUROASPIRE III and IV. The proportion of smokers who did not intend to quit was significantly greater in EUROASPIRE IV compared with III. The prevalence of overweight or obesity was high and identical in both surveys. No significant differences were observed in physical activity. In participants not on blood pressure lowering treatment an elevated blood pressure was observed in 47% in both EUROASPIRE III and IV. In participants not on lipid lowering drugs the low-density lipoprotein cholesterol was ≥2.5 mmol/l in 87% and 88% in EUROASPIRE III and IV respectively. In participants free from known diabetes fasting plasma glucose was ≥7 mmol/l in 12% and 18% in EUROASPIRE III and IV. In subjects with known arterial hypertension blood pressure was at or below guideline recommended targets in 28% in EUROASPIRE III and 35% in IV. In participants on lipid lowering drugs the low-density lipoprotein cholesterol was < 2.5 mmol/l in 28% and 37% in EUROASPIRE III and IV. Glycated haemoglobin was < 7.0% in participants with known diabetes in 62% and 60% in EUROASPIRE III and IV. CONCLUSIONS: The results from EUROASPIRE III and IV clearly demonstrate that the control of modifiable risk factors in people at high cardiovascular disease risk remains poor.

Calcium Channel Blockers--Benefits Upon Vascular Biology in Hypertensive Patients.

Calcium channel blockers (CCB) are widely used in cardiovascular medicine expressing high hopes upon decreasing cardiovascular risk, morbidity and mortality. Here, the potency of CCBs on 58 Romanian asymptomatic hypertensive patients, with no atherothrombotic cardiovascular disease, was studied by clinical and in silico methods. In our study, arterial elasticity/stiffness was assessed; anthropometric, metabolic (lipidic) parameters were quantified. We concluded that lercanidipine 10 mg once daily, during three weeks, is able to dramatically improve central aortic systolic blood pressure, aortic pulse wave velocity. Lipid profile improvement is an essential condition to improve elastic vascular properties in order to decrease the risk for further cardiovascular events. Besides, the potency of lercanidipine is expressed as the contribution of molecular descriptors (van der Waals and solvent accessible surface areas), electronic (molecular polarisability) and hydrophobic (water/octanol partition coefficient) by means of blocker effect on calcium channel, compared with cilnidipine and other 30 dihydropyridines, using molecular simulation techniques.

Non-High-Density Lipoproteins Cholesterol and Cardio-Metabolic Risk.

BACKGROUND: The concept of cardio metabolic risk and risk stratification for cardiovascular events are two distinct entities related with different stages of vascular development of the atherogenic process. In our analytical transversal study, we analyzed non-high-density lipoprotein cholesterol behavior and the correlations with traditional cardiovascular risk factors in a subpopulation with coronary pain and indication of angio coronarography. We tried to build a mathematical model in order to predict the non-HDLc, allowing additional cardiovascular risk reassesment. METHODS: We included 214 patients hospitalized for symptoms and signs suggestive of coronary artery disease and thus indication of vascular invasive evaluation. The protocol of the vascular evaluation included: assessment of cardiovascular risk for fatal cardiovascular event within the next 10 years, the lipidic risk profile, coronarography and statistical analysis. RESULTS: We found a positive and highly statistically significant association between carotid artery intima-media thickness (c-IMT) and non-HDLc value (p <0.001). The mathematical model of linear regression showed the variability of non-HDLc depending on the following numeric variables: total cholesterol (TC), low density lipoproteins (LDL), triglycerides (TG), metabolic syndrome (MS); 97.5% of the non-HDLc variability was dependent on these variables. CONCLUSIONS: Non-HDLc is a useful prognostic factor in cardio-metabolic risk quantification. The interdependent relation between non-HDLc and cardio-metabolic risk factors justifies the inclusion of this parameter in cardio-metabolic risk prediction equation in subjects with metabolic syndrome.

Smoking prevalence in coronary patients from EuroAspire III Romania.

OBJECTIVE: Evaluating smoking incidence, the compliance to smoking cessation recommendation and benefits of quitting smoking in coronary patients included in EuroAspire III Romania survey. MATERIALS AND METHODS: We evaluated the acute cardiovascular events (MACE) incidence in 530 consecutive coronary patients (> or = 18 years and < 80 years at the time ofidentification) with first or recurrent clinical diagnosis or treatments for coronary heart disease, retrospectively identified from diagnostic registers or hospital discharge lists. The coronary events for hospital admission were: elective or emergency coronary artery by-pass graft (CABG), elective or emergency percutaneous transluminal coronary angioplasty (PTCA), acute myocardial infarction (AMI) and unstable angina (UA). The starting date for identification was not less than 6 months and not more than 3 years prior to the expected date ofinterview. Patients were divided in three groups according to their condition of smoker (smoking at interview moment), ex-smoker (quitting smoking prior to interview moment) and no smoker (never smoking). RESULTS: Smoking incidence before hospital admission for coronary event was 68.3% and 10% after hospital discharge. Prior the coronary event, percentage of male smokers (77.15%) predominated by female smokers (42.64%) - p<0.05, OR=4.54. Male smokers (67.25%) were more compliant to smoking cessation recommendation compared to females (32.35%) - p=0.04, OR=2.16; there was no significant difference between the two sexes concerning smoking incidence at interview moment (p>0.05). Patients who continued smoking after hospital discharged presented an increased frequency of MACE compared to non smokers (p=0.043, OR=1.98). Also, patients who continued smoking till hospitalization for coronary event, presented a higher risk compared to non smokers concerning re-intervention by PTCA (p=0.017, OR=4.28) and AMI incidence (p=0.01, OR=4.89). The MACE incidence was higher in active smokers versus passive smokers, but there was no significant differences between the two groups (p>0.05). CONCLUSION: Majority of coronary patients renounced smoking after their first experience with cardiovascular events, a small part continued smoking. Patients who continued smoking after the acute event had higher incidence of MACE compared to non-smokers or ex-smokers (p<0.05). Also, MACE incidence was higher in active smokers versus passive but the difference was not significant between the two groups (p>0.05).

Lifestyle, cardio-metabolic risk and arterial stiffness.

UNLABELLED: HDL-cholesterol plays a key role defining the functional state of the arteries and the relation to cardiovascular risk. AIM: To assess the degree of arterial stiffness in asymptomatic subjects with and without cardiovascular risk, depending on lipidic parameters behavior and on the insulin resistance state. METHODS: Arterial stiffness was assessed using the carotid-radial pulse wave velocity (PWV-CR) measured with Complior; cardiovascular risk was calculated using the SCORE chart; metabolic risk was quantified by assessing fasting lipidic (TC, TG, HDL, LDL) and glycemic parameters (HOMA-IR >1 defines the insulin resistance state). RESULTS: 58 asymptomatic subjects, 57.62 +/- 14.40 years: 46.55% with (SCORE > or = 5%) and 53.45% without (SCORE < 5%) cardiovascular risk. In subjects with SCORE < 5% and low HDL (< 40 mg/dL), PWV-CR is influenced by the TG/HDL ratio (R2=0.27, p=0.04); LDL < 115 mg/dL has a powerful influence on PWV-CR (R2=0.58, p=0.02); the association of lipidic alterations is predictive for increased PWV-CR (> or = 9.5 m/s) (R2=0.85, p=0.008). In subjects with SCORE > or = 5%, protective HDL level (> or = 40 mg/dL) and HOMA-IR > 1, PWV-CR is strongly related to the insulin resistance state (R2=0.74, p=0.02), also to the association with LDL levels (R2=0.92, p=0.01). CONCLUSIONS: The association between low HDL levels and other lipidic alterations in asymptomatic subjects with low cardiovascular risk influences the degree of arterial stiffness. Increased HDL levels and the presence of insulin resistance syndrome in high risk asymptomatic subjects are predictive for arterial stiffness. This prediction is amplified by LDL association to the metabolic state of the insulin resistance syndrome. It is necessary to establish target levels for HDL and TG in the cardiovascular disease prevention guidelines.

Environmental factors and cardiovascular risk in young individuals.

UNLABELLED: Normal endothelial function alters physiologically with aging. Intervention of environmental factors precipitates and accelerates endothelial dysfunction progression, correlated with cardiovascular risk. AIM: To study the impact of environmental factors (smoking, nutritional habits, stress, physical activity) on the imbalance of the endothelial commuting threshold. METHODS: The questionnaire method was applied in order to identify and quantify the presence of environmental factors; an anthropometrical physical exam was performed; metabolic profile (insulin resistance HOMA-IR, lipid parameters) was assessed. Arterial elasticity was assessed with Complior (Artech Medical). RESULTS: The studied lot (n=80, 21.16 +/- 2.43 years) comprised young medicine students and showed a high incidence of: smoking (31.25%), unhealthy nutritional habits (60%), stress (60%), sedentary lifestyle (25%). The odds for endothelial function alteration were significant only in subjects who associated stress and smoking (OR=8.18, p=0.0006); in the same group, there was noticed the tendency for metabolic profile alteration, meaning insulin resistance (OR=1.19, p=ns). The association stress-smoking did not significantly influence the unhealthy nutritional habits (p=ns, OR=2.39), lipoprotein anomalies (TC > or = 190 mg/dL: p=ns, OR=0.98; LDL > or = 130 mg/dL: p=ns, OR=3.53), or the sedentary lifestyle (p=ns, OR=0.80). CONCLUSIONS: The main environmental factors which determine endothelial function imbalance in young ages are smoking and occupational stress. It is a positive stress which does not lead to significant metabolic anomalies or lifestyle changes. Though, this kind of stress leads to an unhealthy behavior: smoking. The association stress-smoking is essential in endothelial function alteration in young subjects. Primary cardiovascular prevention must focus drastically on unhealthy behaviors correction to reduce cardiovascular risk in young individuals.