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Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C. Background Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD). Purpose The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin America. Methods We analyzed cross-sectional data from the 634 participants aged 35-74 with CHD from the community-based CESCAS Study. We calculated the prevalence for counts of cardiometabolic (hypertension, dyslipidemia, obesity, diabetes) and lifestyle (current smoking, unhealthy diet, low physical activity, excessive alcohol consumption) RF. Differences in RF number between men and women were tested with age-adjusted Poisson regression. We identified the most common RF combinations among participants with ≥ 4 RF. We performed a subgroup analysis by educational level. Results The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Obesity, central obesity, diabetes and low physical activity were more common in women, while excessive alcohol consumption and unhealthy diet were more common in men. Close to 85% of women and 81.5% of men presented with ≥ 4 RF. Women presented with a higher number of overall (relative risk (RR) 1.05, 95% CI 1.02-1.08) and cardiometabolic RF (1.17, 1.09-1.25). These sex differences were found in participants with primary education (RR women overall RF 1.08, 1.00-1.15, cardiometabolic RF 1.23, 1.09-1.39), but were diluted in those with higher educational attainment. The most common RF combination was hypertension/dyslipidemia/obesity/unhealthy diet. Conclusion Women in the CESCAS study showed a higher burden of multiple cardiovascular RF. Sex differences persisted in participants with low educational attainment, and women with low educational level had the highest RF burden.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The following companies have supported the EORP programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript. Background Hypertension is a highly prevalent cardiovascular risk factor, and yet a large proportion of patients with coronary heart disease (CHD) have uncontrolled hypertension. Awareness has been proposed as a factor that can influence hypertension management. Understanding factors that may improve hypertension control in CHD patients is essential due to their high cardiovascular risk. Goal: We aim to explore the distribution and association of hypertension control and awareness in hypertensive patients with established CHD. Methods We analysed data from ESC-EORP EUROASPIRE V, a cross-sectional study including 9018 CHD patients in 27 countries, with data collected through medical records, interview and physical examination. Hypertension was defined by blood pressure (BP) level at physical examination, antihypertensive medication use, and hypertension history. Controlled hypertension was defined as BP <140/90mmHg (140/85mmHg in diabetics). Awareness was studied as awareness of the patient’s BP level, and of the patient’s BP target. Patients were considered aware if they reported to be aware of their latest BP level and their target, and if they indicated their actual and target BP levels correctly (±10mmHg). We used logistic regression with hypertension control as outcome and awareness as determinant. Separate models were fit for actual BP level and BP target level awareness as determinants. We additionally performed a subgroup analysis by middle-income (MIC) and high-income (HIC) countries. Results 5896 subjects were considered hypertensive, from which 39.6% were controlled. 79.2% of patients were aware of their BP level, and 84.5% were aware of their BP target. Hypertension control was more common in HICs (41.3%) than in MICs (35.2%). Patients aware of their BP level (OR 0.47, 95%CI 0.39-0.57) and of their target (0.36, 0.28-0.46) were less likely to have controlled hypertension, compared to unaware patients. Furthermore, hypertension control was associated with age <65 years (0.43, 0.37-0.51 own BP awareness model; 0.43, 0.35-0.52 BP target awareness model), BMI <25 kg/m2 (0.46, 0.37-0.56 own BP awareness model 0.5 0.39-0.64, BP target awareness model) and male sex (1.31,1.09-1.58, own BP awareness model; 1.39, 1.1-1.74 BP target awareness model). Higher education was associated with hypertension control in HICs (1.41, 1.01-1.97 own BP awareness model). Conclusion Control was low in the hypertensive study participants, and it was lower in MICs. Awareness levels were generally high, although it is concerning that 20.7% and 15.5%% of hypertensive patients were not aware of their BP level and their target respectively. Patients with uncontrolled hypertension were more likely to be aware of their own BP level and target. Controlled patients may have a lower risk perception. It is important that prevention efforts work on improving the awareness to prevent development uncontrolled hypertension in the future.

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C. Background Clinical guidelines recommend cardioprotective medication use in coronary heart disease (CHD) patients. Underuse of these drugs is common among patients of low resources, which may be explained by insufficient access in the public sector. Aim We aim to assess medication use and barriers to care by insurance coverage in subjects with CHD in the Southern Cone of Latin America. Methods We analysed cross-sectional data from 593 participants with CHD residing in Argentina, Chile and Uruguay, within the CESCAS community-based cohort study. Participants were categorized as covered by public insurance only or having additional coverage (social security or private insurance). We calculated the prevalence of recommended medications use, mean number of medications, use of ≥ 1 and ≥ 2 drugs, and reported barriers to needed care in insured and uninsured participants. Differences between coverage groups were assessed with univariable and multivariable analysis (logistic and Poisson regression) adjusted by age, sex, previous revascularization, educational level and barriers. Results Medication use ranged from 39.8% (lipid-lowering) to 84.1% (antihypertensives). Mean number of medications was 1.8 (SE 0.1), 95.4% used ≥ 1 drugs, and 59.8% used ≥ 2 drugs. There were no significant differences by coverage in medication use, except for higher ACE-inhibitor and nitrate use among participants in the public sector (35.8% vs. 53.2%, p=0.001; and 1.5% vs. 5.2%, p=0.047 respectively). In the multivariable analysis, having public coverage only was not significantly associated with medication use, but it was with reporting barriers to care (OR 2.06, 95% CI 1.21-3.52). Conclusion Insurance coverage was not associated with the use of most medications in CHD patients in the Southern Cone of Latin America, possibly due to public health programs providing them free of charge. Uninsured participants more often face barriers to access medical care, and future studies should address these healthcare inequalities.

Introduction SURF CHD (Survey of Risk Factors in Coronary Heart Disease) is a clinical audit on secondary prevention among CHD patients aiming to simplify recording and assessment of risk factors and medication. The second wave of the study (SURF CHD II) uses a novel recruitment strategy that provides a wider and more representative picture of CHD secondary prevention. Methods The survey is conducted during outpatient visits and collects data on demographics, risk factor history and measurements, and medications. The novel recruitment strategy is based on the network of European Association of Preventive Cardiology (EAPC). National Cardiovascular disease Prevention Coordinators (NCPC) appointed by the EAPC were invited; national cardiac societies (NCS) were invited in countries without NCPCs; and interested clinicians may also participate. SURF researchers discussed tailor-made approaches to implement the audit with national representatives. Results 48 NCPCs, 11 NCS and 9 individual contacts were invited. 95 centres in 31 countries are participating and have enrolled 6966 participants in 5 regions: 109 in Eastern Mediterranean, 5170 in Europe, 108 in Americas, 1563 in South East Asia and 16 in Western Pacific. 24.4% of participants were female and mean age was 63.8±18 years. 75.3% of the study population had BMI≥25kg/m2 and 20.0% were smokers. Blood pressure <140/90mmHg was recorded in 61.8% of participants, 26.4% had LDL <1.8 mmol/l and 40,1% had HbA1c<7%. South East Asia recorded the lowest prevalence of BMI≥25kg/m2 and LDL levels. Lowest use of statins was recorded in Europe and of angiotensin-converting enzyme inhibitors in Americas. Conclusions The novel recruitment strategy proved to be practicable. Preliminary results indicate regional variations in risk factors and secondary prevention. SURF will continue to collaborate with NCPCs and NCS to achieve a broader insight on CHD secondary prevention with a simplified tool. Key messages Cardiovascular risk factor prevalence in coronary patients is high and presents regional variations. SURF is a simplified clinical auditing tool useful to assess risk factor recording and management. Centre enrolment for the study based on the network of a renowned association of cardiology is practicable and helps to provide a wide picture of secondary prevention of coronary heart disease.