The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention

Abstract

The Joint European Societies (JES) guidelines on cardiovascular disease (CVD) prevention published in 1994, 1998, 2003, 2007, 2012 and 2016 defined lifestyle and risk factors targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. Guideline implementation in Europe has been evaluated with four cross-sectional EUROASPIRE surveys starting in mid-1990s. The results showed poor lifestyle and risk factor management in patients with CHD and in high CVD risk people with high prevalences of smoking, obesity, central obesity and diabetes. The control of blood pressure, lipids and glucose was far from optimal. A comparison across the recent three surveys provided a unique description of time trends for secondary prevention over a period of 14 years. The results showed adverse lifestyle trends, a substantial increase in obesity, central obesity and diabetes. Despite significant improvement of blood pressure and lipid control many patients were not reaching the risk factor goals and there was no change in glucose control. Comparing the most recent two surveys, there were no major differences in lifestyle and risk factor management in people at high risk of developing CVD. A new approach to CVD prevention integrating primary and secondary prevention into a modern preventive cardiology programme, focusing on lifestyle and risk factor management is required, in order to reduce the risk of CVD events and improve quality of life in patients with CHD and those at high risk of developing CVD.

The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease

“…The surveys demonstrate that large proportions of patients do not achieve the recommended targets for CVD prevention. 98 In EUROASPIRE IV, examining 6,187 patients with established CAD, 46% had no T2DM, 19% had newly diagnosed T2DM and 35% had previously known T2DM. The combined use of cardio-protective drugs was 53%, 55% and 60% in these groups.…”

“…It has a long asymptomatic period during which serious complications can develop, there are simple validated questionnaires and reliable diagnostic tests and interventions for glucose, blood pressure and lipids are effective. 97,98 However, large-scale population screening programmes, such as those that have been established for colon and breast cancer, have not been proven to be cost effective for T2DM. If screening through outreach strategies other than the primary care centres were shown to be cost effective and the impressive effects of SGLT2 inhibitors and GLP-1 receptor analogues on cardiovascular outcomes in people with T2DM at high cardiovascular risk also apply to those at lower cardiovascular risk, screening for dysglycaemia in a broader perspective could perhaps be justified.…”

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

“…Especially low control rates were found for LDL-C (4.5%) and body weight parameters (15%). Numerous observational studies, including previous EUROASPIRE surveys, concluded that control of multiple cardiovascular risk factors is poor in clinical practice [20,[23][24][25][26][27], and it is even more difficult to achieve the targets in the primary prevention setting than in coronary patients [20]. In the primary care arm of EUROASPIRE IV, less than half (43%) of the treated patients reached the blood pressure target, one-third (33%) of patients achieved the LDL-C target of <2.5 mmol/L and less than two-thirds (59%) achieved the HbA1c target of <7.0%.…”

“…In the primary care arm of EUROASPIRE IV, less than half (43%) of the treated patients reached the blood pressure target, one-third (33%) of patients achieved the LDL-C target of <2.5 mmol/L and less than two-thirds (59%) achieved the HbA1c target of <7.0%. No major differences in the control of lifestyle and risk factors in people at high risk of developing CVD were observed between the EUROASPIRE III and IV surveys [20]. The European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA) reported that among outpatients with varying degrees of CVD risk, less than half of the treated hypertensive and dyslipidemic patients and a third of the diabetic patients attained treatment goals.…”

“…The number of participating countries increased from nine countries in the first EUROASPIRE survey to 27 countries in the fifth survey. Starting from the EUROASPIRE III, the surveys also included a primary care arm, i.e., individuals at high CVD risk because of hypertension, dyslipidemia or type 2 diabetes mellitus (T2DM) [20].…”