EUROASPIRE III: Treatment fails to meet standards of international guidelines


Large proportions of European coronary patients are failing to achieve lifestyle, risk factor and therapeutic targets for the prevention of further disease, according to results of the third EUROASPIRE survey. The survey, conducted on behalf of the European Society of Cardiology, analysed medical records and interviewed almost 9,000 patients with coronary heart disease in 22 countries of Europe.

“It is a matter of the greatest professional concern that so many coronary patients are not being managed to the standards set in European prevention guidelines and as a result are at increased risk of atherosclerotic disease and a shorter life expectancy,” said Professor David Wood, National Heart & Lung Institute in London, UK, the principal investigator of EUROASPIRE III.

EUROASPIRE III is the third survey of the series and was carried out in 2006-2007 in patients from 76 coronary care centres in Europe. Consecutive patients with a diagnosis of coronary heart disease were identified and interviewed and examined at least six months after their coronary event.

Results from the interviews showed that:

  • 17% smoked cigarettes;
  • 35% were obese;
  • 53% were centrally obese;
  • 56% had blood pressure levels above target (140/90mmHg, 130/80mmHg for patients with diabetes);
  • 51% had serum cholesterol levels above target (4.5mmol/l);
  • 25% had a history of diabetes, of whom only 10% were adequately controlled (fasting glucose levels under 6.1mmol/l).

The report, published on 12 March, 2009 by the European Journal of Cardiovascular Prevention and Rehabilitation, also found that the use of cardioprotective medication was below recommendations.

Lifestyle, risk factor and therapeutic targets for the prevention of cardiovascular disease are clearly set out in the Joint European Societies guidelines, and give the highest priority to those with coronary disease. Among the goals of the guidelines are to stop smoking, follow a healthy diet, be physically active, maintain a maximum body mass index of 25 kg/m2, blood pressure no higher than 140/90mmHg (130/80 in diabetics) and total cholesterol no higher than 4.5mmol/l.

Detailed results showed that almost one-third of all EUROASPIRE subjects were smokers in the month prior to their event, and this proportion had fallen by around half by the time of interview. Only one in seven patients was advised to attend a smoking cessation service, and only one-third of those actually did so.

Forty per cent of patients reported no increase in physical activity after their event, and only one-third reported doing regular exercise to increase their physical fitness. One in five obese patients said they had never been told they were overweight, one half had not followed dietary advice to lose weight, and almost two-thirds had not increased their physical activity.

“These results show that, despite the existence of clear, evidence-based guidelines, their integration into routine clinical care is still disappointing, and there is still much room throughout Europe to raise the standards of preventive cardiology,” Wood said.