Sobering News From Europe: CVD Risk Factors Are on the Rise or Holding Firm

MUNICH, Germany—Alarms bells should be going off in Europe as results of a survey conducted in 21 countries show that control of most key cardiovascular risk factors has stagnated or worsened among patients with coronary heart disease over the past 5 years.

People are smoking more, exercising less, and becoming less likely to attend cardiac rehabilitation programs, Kornelia Kotseva, MD, PhD (Imperial College London, England), reported here at the European Society of Cardiology Congress 2018. Rates of overweight and obesity remain unchanged, and patients aren’t doing any better with controlling blood pressure or diabetes.

The one semibright spot? Lipid management has improved, although seven in every 10 patients remain above the LDL cholesterol target recommended in the most recent European CVD prevention guidelines.

“The adverse lifestyle trends are a major cause for concern,” Kotseva said. Panelists at her presentation agreed, describing the results as “very sobering” and “very depressing.”

Kotseva concluded: “We believe that matching high-quality interventional cardiology services with modern preventive cardiology programs is required for all patients with coronary heart disease.”

The discouraging news came from a look at changes in achievement of various goals included in the prevention guidelines between the EUROASPIRE IV survey conducted in 2013-2015 (n = 6,905) and the EUROASPIRE V survey conducted in 2016-2018 (n = 4,793). The surveys targeted patients with coronary heart disease who were younger than 80 and who had been hospitalized more than 6 months but less than 3 years before the interview for ACS or elective coronary revascularization. The mean age of the participants was 64, and roughly one-quarter were women. Respondents to EUROASPIRE V were more likely than those in the prior survey to have a previous hospitalization for PCI (85% vs 65%).

Trends in risk factor control between the two surveys mostly went in the wrong direction:

• The prevalence of current smoking increased from 16% to 19%, with the greatest increase observed in women younger than 60.
• Roughly 80% of patients remained overweight, with 37% being obese.
• The percentage of patients who reported meeting the physical activity goal of more than 30 minutes five times a week declined from 44% to 34%.
• No gains were seen in blood pressure control, with half of patients continuing to have uncontrolled levels despite use of antihypertensive drugs.
• There was an uptick in self-reported diabetes from 26% to 30%. In this group, more than 40% had an HbA1c level above the goal of less than 7%, with most failing to achieve LDL cholesterol and blood pressure targets.
• Use of major classes of cardioprotective medications remained unchanged, although 93% of patients were on antiplatelets and more than 80% were taking beta-blockers, antihypertensives, and statins. About three-quarters were taking ACE inhibitors or angiotensin receptor blockers.

According to Kotseva, “probably the only good news” is that lipid control improved, with falling proportions of patients above various thresholds of total, LDL, and non-HDL cholesterol. Still, the proportion of patients with an LDL cholesterol level above the goal of less than 1.8 mmol/L (70 mg/dL) remained high at 71%, even with a decline from 82%.

One of the reasons for the poor risk factor control, Kotseva said, could be found in the numbers regarding participation in cardiac rehab programs. Only about half of patients reported being advised to attend such a program in both surveys, but the proportion who participated if advised dropped from 82% to 69%. Worse still, overall participation declined to just 34% in the latest survey.

Kotseva said it’s important to focus not just on coronary interventions, but on prevention afterwards, even before patients are sent home.

“We have to have these patients invited to this program before they are discharged so we will have better attendance,” she said.