Highlights
- •Most patients with established coronary artery disease have suboptimal lipid management.
- •More professional strategies are needed aiming at lifestyle changes and LLT adapted to the need of the individual patient.
- •The striking variability between countries and centers with several examples of well managed patients illustrates that the present conditions can be improved.
Abstract
Background and aims
One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well
European guidelines on the management of dyslipidaemias are implemented in coronary
patients.
Methods
Standardized methods were used by trained technicians to collect information on 7824
patients from 130 centers in 27 countries, from the medical records and at a visit
at least 6 months after hospitalization for a coronary event. All lipid measurements
were performed in one central laboratory. Patients were divided into three groups:
on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity
LLT and on no LLT.
Results
At the time of the visit, almost half of the patients were on a high-intensity LLT.
Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted
in 20.8% of the patients and had been started or increased in intensity in 11.7%.
In those who had interrupted LLT or had reduced the intensity, intolerance to LLT
and the advice of their physician were reported as the reason why in 15.8 and 36.8%
of the cases, respectively. LDL-C control was better in those on a high-intensity
LLT compared to those on low or moderate intensity LLT. LDL-C control was better in
men than women and in patients with self-reported diabetes.
Conclusions
The results of the EUROASPIRE V survey show that most coronary patients have a less
than optimal management of LDL-C. More professional strategies are needed, aiming
at lifestyle changes and LLT adapted to the need of the individual patient.
Graphical abstract
Graphical Abstract
Keywords
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References
- Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.Eur. Heart J. 2015; 36: 1163-1170
- Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes.N. Engl. J. Med. 2018; 379: 633-644
- Prevention of coronary heart disease in clinical practice. Recommendations of the task force of the european society of Cardiology, european atherosclerotic society and european society of hypertension.Eur. Heart J. 1994; 15: 1300-1331
- Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention.Eur. Heart J. 1998; 19: 1434-1503https://doi.org/10.1053/euhj.1998.1243
- European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts).Eur. J. Cardiovasc. Prev. Rehabil. 2003; 10: S1-S78
- European guidelines on cardiovascular disease prevention in clinical practice: fourth joint task force of the european society of Cardiology and other societies on cardiovascular disease prevention in clinical prevention in clinical practice (constituted by representatives of nine societies and by invited experts).Eur. J. Cardiovasc. Prev. Rehabil. 2007; 14: S1-S113
- European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the european society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the european association for cardiovascular prevention & rehabilitation (EACPR).Eur. Heart J. 2012; 33: 1635-1701
- European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the european society of Cardiology and other societies on cardiovascular disease prevention in clinical practice.Eur. Heart J. 2016; 37 (2016): 2315-2381
- EUROASPIRE. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results.Eur. Heart J. 1997; 18: 1569-1582
- Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II. Euro Heart Survey Programme.Eur. Heart J. 2001; 22: 554-572
- Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries.Lancet. 2001; 357: 995-1001
- On behalf of EUROASPIRE III Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries.Eur. J. Cardiovasc. Prev. Rehabil. 2009; 16: 121-137
- Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries.Lancet. 2009; 373: 929-940
- On behalf of the EUROASPIRE Investigators. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.Eur. J. Prev. Cardiol. 2015; 23: 636
- Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology.Cardiovasc. Diabetol. 2015; 14: 133
- Treatment potential for dyslipidaemia management in patients with coronary heart dise ase across Europe: findings from the EUROASPIRE III survey.Atherosclerosis. 2013; 231: 300-307
- On behalf of the EUROASPIRE Investigators. 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.Eur. J. Prev. Cardiol. 2019; (febr 10th)
- Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy.J. Am. Coll. Cardiol. 2006; 48: 438-445
- For the ODYSSEY OUTCOMES committees and investigators . Alirocumab and cardiovascular outcomes after acute coronary syndrome.N. Engl. J. Med. 2018; https://doi.org/10.1056/NEJMoa1801174
- FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease.N. Engl. J. Med. 2017; 376: 1713-1722https://doi.org/10.1056/NEJMoa1615664
- Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease.JAMA Cardiology. 2016; https://doi.org/10.1001/jamacardio.2016.4052
- Cholesterol treatment trialists'(CTT) collaboration. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials.Lancet. 2015; 385: 1397-1405
- Better diet quality and decreased mortality among myocardial infarction survivors.JAMA Intern. Med. 2013; 173: 1808-1819
- Association of diet, exercise and smoking modification with risk of early cardiovascular events after acute coronary syndromes.Circulation. 2010; 121: 750-758
- The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a meta-analysis.Prev. Med. 2003; 37: 283-290
- Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile. Review, synthesis and recommendations.Sports Med. 2014; 44: 211-221
- Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries – findings from the EUROASPIRE IV survey.Atherosclerosis. 2016; 246: 243-250
- Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study.Eur. J. Prev. Cardiol. 2013; 20: 678-685
- Retrospective examination of lipid lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines.BMJ open. 2017; 7e013255
- Simplifying the audit of risk factor recording and control: a report from an international study in 11 countries.Eur. J. Prev. Cardiol. 2016; 23: 1202-1210
- Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada.Eur. J. Prev. Cardiol. 2012; 19: 221-230
- For the ICLPS investigators. Achievement of low-density lipoprotein cholesterol goals in 18 countries outside western europe: the international ChoLesterol management practice study (ICLPS).Eur. J. Prev. Cardiol. 2018; 25: 1087-1094
- Effect of intensive lipid-lowering therapy on mortality after acute coronary syndrome (a patient-level analysis of the aggrastat to zocor and pravastatin or atorvastatin evaluation and infection therapy-thrombolysis in myocardial infarction 22 trials).Am. J. Cardiol. 2007; 100: 1047-1051
- Impact of statin dose on major cardiovascular events: a mixed treatment comparison meta-analysis involving more than 175,000 patients.Int. J. Cardiol. 2013; 166: 431-439
- The efficacy and safety of intensive statin therapy: meta-analysis of randomized trials.CMAJ (Can. Med. Assoc. J.). 2008; 178: 576-584
- ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the european society of Cardiology (ESC) and the european atherosclerosis society (EAS).Eur. Heart J. 2011; 32: 1769-1818
- ESC/EAS guidelines for the management of dyslipidaemias.Eur. Heart J. 2016; 37 (2016): 2999-3058
- Patterns of statin initiation, intensification, and maximization among patients hospitalized with an acute myocardial infarction.Circulation. 2014; 113 (CIRCULATION AHA)003589
- American association of clinical endocrinologists and American college of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease.Endocr. Pract. 2017; 23: 1-87
- AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American college of Cardiology/American heart association task force on clinical practice guidelines.J. Am. Coll. Cardiol. 2018; ([published online November 10, 2018])https://doi.org/10.1016/j.jacc.2018.11.003
- REDUCE-IT Investigators. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.N. Engl. J. Med. 2019; 380: 11-22https://doi.org/10.1056/NEJMoa1812792
- Trends in gender differences in cardiac care and outcome after acute myocardial infarction in Western Sweden: a report from the Swedish web system for enhancement of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART).J. Am. Heart. Assoc. 2015; e001995
- Contemporary trends of optimal evidence-based medical therapy at discharge from patients surviving acute myocardial infarction from the Korea acute myocardial infarction registry.Clin. Cardiol. 2015; 38: 350-356
- Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey.Eur. J. Prev. Cardiol. 2018; https://doi.org/10.1177/2047487318781359
- Cardiovascular disease (CVD) risk factors in older adults - perception and reality.Arch. Gerontol. Geriatr. 2015; 61: 88-92
Article info
Publication history
Published online: April 23, 2019
Accepted:
March 19,
2019
Received in revised form:
February 22,
2019
Received:
January 16,
2019
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier B.V. All rights reserved.
