Lifestyle, risk factor and medication management targets among patients with acute coronary syndrome in Europe

1. 1
SUBOPTIMAL ACHIEVEMENT OF LIFESTYLE, RISK FACTOR AND
MEDICATION MANAGEMENT TARGETS AMONG PATIENTS WITH
ACUTE CORONARY SYNDROME IN EUROPE
[Excerpt] Copyright © Lorena Tonarelli, M.Sc. 2017
As shown in Table 2 and Figure 1, at interview the prevalence of smoking, persistent
smoking (at time of event), overweight (BMI ≥ 25 kg/m2
), obesity (BMI ≥ 30 kg/m2
),
elevated blood pressure (≥ 140/90mmHg), raised low-density lipoprotein cholesterol
(≥ 1.8 mmol/l) and self-reported diabetes mellitus were 16.0%, 48.6%, 82.1%,
37.6%, 42.7%, 80.5% and 26.8%, respectively. Additionally, 59.9% of patients
reported low or no level of physical activity.
Table 2. Prevalence (%) of risk factors at interview, by country, gender and age.
Country Current
smoking1
Persistent
smoking2
Overweight3
Obesity4
BP
≥140/90
mmHg
LDL-C
≥ 1.8
mmol/L
Self-
reported
diabetes
Belgium
Bosnia & Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Finland
France
Germany
Greece
Ireland
Latvia
Lithuania
Netherlands
Poland
Romania
Russia
Serbia
Slovenia
Spain
Sweden
Turkey
Ukraine
United Kingdom
8.2
17.4
19.2
17.6
27.8
17.6
7.5
25.2
11.9
19.6
16.9
12.2
18.0
16.3
20.4
11.1
22.6
18.2
9.8
11.6
13.9
25.5
13.9
16.1
38.8
33.8
60.0
55.0
47.1
51.9
53.4
70.7
52.0
52.6
50.0
48.0
52.4
50.0
51.8
29.7
64.5
37.6
44.4
26.8
50.0
53.0
47.4
61.0
79.6
81.4
84.2
83.5
85.4
85.5
78.9
75.5
85.3
80.4
87.5
84.2
83.4
76.9
81.0
84.3
93.1
76.2
87.7
79.7
76.0
80.9
81.0
80.5
30.3
26.6
43.3
37.1
41.6
41.9
37.7
36.0
36.7
33.3
38.5
40.2
44.9
29.4
37.2
46.0
50.8
25.8
49.4
31.4
26.7
40.7
38.0
35.8
43.4
55.7
35.8
50.6
52.2
48.8
34.1
43.2
46.7
29.4
24.9
40.9
57.8
52.9
50.0
28.2
25.4
34.8
44.7
40.7
37.6
41.2
42.7
44.8
85.5
88.5
92.9
79.0
79.4
77.4
67.4
73.8
89.3
84.4
65.8
70.6
95.9
79.2
78.9
79.8
87.4
88.5
69.1
59.4
81.3
91.7
88.2
70.8
23.0
21.2
30.8
26.3
34.8
36.2
24.6
32.1
25.4
41.2
15.1
20.5
18.6
20.0
31.4
32.8
20.1
26.1
36.9
32.9
28.2
36.2
22.6
32.7

2. 2
1
Smoking: self-reported smoking or > 10 ppm carbon monoxide in breath.
2
Persistent smoking: self-reported smoking or > 10 ppm carbon monoxide in breath in patients reporting to have been smoking in the
month prior to the index event.
3
Overweight: body mass index (BMI) ≥ 25 kg/m
2
.
4
Obesity: BMI ≥ 30 kg/m
2
.
BP: Blood pressure; LDL-C: Low-density lipoprotein cholesterol; MOR: Median odds ratio.
Source: Koseva et al. (2016)
1
Figure 1. Prevalence of smoking, persistent smoking, overweight, obesity, elevated
blood pressure, raised low-density lipoprotein cholesterol and self-reported diabetes
mellitus at interview, by gender.
BP: Blood pressure; DM: Diabetes mellitus; LDL-C: Low-density lipoprotein cholesterol.
Source: Koseva et al. (2016)
1
Reported cardioprotective medications at interview, shown in Table 3 and Figure 2,
were antiplatelets (93.8%), beta-blockers (82.6%), angiotensin-converting enzyme
(ACE) inhibitors or angiotensin receptor blockers (ARBs) (75.1%) and statins
(85.7%). Participation in a cardiac prevention and rehabilitation programme was
18
49
83
36
42
79
26
11
45
80
44 44
84
30
0
20
40
60
80
100
%
Men Women
MOR
95% CI
1.40
1.23-1.58
1.43
1.24-1.63
1.30
1.16-1.43
1.30
1.18-1.41
1.41
1.25-1.58
1.82
1.46-2.18
1.33
1.19-1.47
Gender
Men
Women
17.6
11.1
49.3
45.4
83.0
79.4
35.6
43.8
42.4
43.8
79.2
84.4
25.7
30.1
Age (years)
< 50
50-59
60-69
≥ 70
33.6
25.2
14.7
5.3
52.3
49.9
47.1
43.2
79.5
84.5
83.1
79.7
39.5
41.2
39.0
32.3
26.3
38.2
44.6
48.7
83.3
82.8
79.4
79.2
14.5
22.6
29.8
29.9
Total 16.0 48.6 82.1 37.6 42.7 80.5 26.8

3. 3
recommended to 50.7% of patients, 81.3% of whom attended 50% or more
sessions.
ACE: Angiotensin-converting enzyme; ARBs: Angiotensin receptor blockers; MOR: Median odds ratio.
Source: Koseva et al. (2016)
1
Table 3. Reported medication (%) at time of interview, by country, gender and
age.
Country Antiplatelets Beta-blockers ACE
inhibitors/ARBs
Statins
Belgium
Bosnia & Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Finland
France
Germany
Greece
Ireland
Latvia
Lithuania
Netherlands
Poland
Romania
Russia
Serbia
Slovenia
Spain
Sweden
Turkey
Ukraine
United Kingdom
95.6
97.8
90.8
96.5
98.9
91.8
91.3
97.9
89.0
96.1
98.5
96.9
85.1
96.4
91.7
92.1
93.4
98.2
94.3
97.1
97.5
95.8
93.4
88.7
79.9
86.7
83.3
74.9
80.0
85.5
79.5
82.0
83.4
78.4
78.6
87.9
84.3
74.5
82.7
87.5
80.1
94.1
86.1
89.5
88.9
84.0
77.7
67.8
49.0
85.4
78.3
79.8
81.1
82.2
60.1
82.0
81.7
62.7
73.1
81.0
79.3
66.7
77.9
71.0
64.0
86.7
79.1
72.1
81.6
75.6
74.0
75.7
94.2
87.6
75.0
80.7
95.6
93.0
81.9
94.2
83.2
96.1
92.5
93.1
73.5
86.5
81.9
87.3
74.6
92.3
88.9
91.9
90.0
78.6
79.9
84.1
MOR
95% CI
1.81
1.41-2.21
1.43
1.24-1.61
1.57
1.39-1.75
1.71
1.39-2.04
Gender
Men
Women
94.3
92.4
82.6
82.5
75.3
74.6
86.4
83.5
Age (years)
< 50
50-59
60-69
≥ 70
95.9
96.3
94.0
90.9
82.5
83.6
84.0
80.1
71.2
74.6
75.3
76.5
87.6
86.8
85.1
85.0
Total 93.8 82.6 75.1 85.7

4. 4
Figure 2. Reported cardioprotective medication (%) at interview, by gender.
ACE: Angiotensin-converting enzyme; ARBs: Angiotensin receptor blockers.
Source: Koseva et al. (2016)
1
DISCUSSION
The results of this survey highlight at least three important challenges in secondary
cardiovascular prevention. Firstly, it is apparent that, although cardioprotective
medication use is high among coronary patients, lifestyle and risk factor control
remains inadequate and fails to meet guideline recommendations. Secondly, access
to prevention and rehabilitation is limited, despite compelling scientific evidence of
their efficacy, in terms of improved quality of life and survival2-5
as well as cost-
effectiveness.6
Thirdly, the high prevalence of inadequate blood pressure control
despite cardioprotective medication use suggests suboptimal titration and dosing,
which may be further aggravated by poor patient adherence.
The findings are in keeping with those of previous international surveys, showing
that secondary prevention guidelines are poorly implemented among European
patients with established coronary heart disease.7-9
Subsequent research, by
Pagidipati et al., found that the proportion of patients with CVD and diabetes
94
83
75
86
92
83
75
84
0
20
40
60
80
100
%
Men Women