Lancet. 2001 Mar 31;357(9261):995-1001. doi: 10.1016/s0140-6736(00)04235-5.
Patients with coronary heart disease (CHD) are the top priority for preventive cardiology. The first EUROASPIRE survey among patients with established CHD in nine countries in 1995-96 showed substantial potential for risk reduction. A second survey (EUROASPIRE II) was done in 1999-2000 in the same countries to see whether preventive cardiology had improved since the first. We compared the proportion of patients in both studies who achieved the lifestyle, risk-factor, and therapeutic goals recommended by the Joint European Societies report on coronary prevention.
The surveys were undertaken in the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Slovenia, and Spain. Consecutive patients (men and women < or = 70 years of age) were identified after coronary-artery bypass graft or percutaneous transluminal coronary angioplasty, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later.
3569 and 3379 patients were interviewed in the first and second surveys, respectively. The prevalence of smoking remained almost unchanged at 19.4% vs 20.8%. The prevalence of obesity (body-mass index > or = 30 kg/m2) increased substantially from 25.3% to 32.8%. The proportion with high blood pressure (> or = 140/90 mm Hg) was virtually the same (55.4% vs 53.9%), whereas the prevalence of high total cholesterol concentrations (> or = 5.0 mmol/L) decreased substantially from 86.2% to 58.8%. Aspirin or other antiplatelet therapy was as widely used in the second survey as the first (83.9% overall), and reported use of beta-blockers, angiotensin-converting-enzyme inhibitors, and especially lipid-lowering drugs increased.
The adverse lifestyle trends among European CHD patients are a cause for concern, as is the lack of any improvement in blood-pressure management, and the fact that most CHD patients are still not achieving the cholesterol goal of less than 5 mmol/L. There is a collective failure of medical practice in Europe to achieve the substantial potential among patients with CHD to reduce the risk of recurrent disease and death.
冠心病患者是预防心脏病学的首要关注对象。1995 - 1996年在9个国家对确诊冠心病患者进行的首次欧洲动脉粥样硬化患病率和干预效果研究（EUROASPIRE）显示，降低风险有很大潜力。1999 - 2000年在相同国家进行了第二次调查（EUROASPIRE II），以了解自首次调查以来预防心脏病学是否有所改善。我们比较了两项研究中达到欧洲心脏病学会联合报告中关于冠心病预防所推荐的生活方式、危险因素及治疗目标的患者比例。
调查在捷克共和国、芬兰、法国、德国、匈牙利、意大利、荷兰、斯洛文尼亚和西班牙相同选定的地理区域及医院进行。连续纳入冠状动脉搭桥术或经皮冠状动脉腔内血管成形术后的患者（年龄≤70岁的男性和女性），或因急性心肌梗死或缺血入院的患者，并在至少6个月后进行访谈。
第一次和第二次调查分别有3569例和3379例患者接受访谈。吸烟患病率几乎未变，分别为19.4%和20.8%。肥胖（体重指数≥30 kg/m²）患病率大幅上升，从25.3%增至32.8%。高血压（≥140/90 mmHg）患者比例基本相同（55.4%对53.9%），而总胆固醇浓度升高（≥5.0 mmol/L）的患病率则大幅下降，从86.2%降至58.8%。第二次调查中阿司匹林或其他抗血小板治疗的使用情况与第一次一样广泛（总体为83.9%），β受体阻滞剂、血管紧张素转换酶抑制剂尤其是降脂药物的使用报告有所增加。
欧洲冠心病患者不良生活方式的趋势令人担忧，血压管理未见改善以及大多数冠心病患者仍未达到总胆固醇低于5 mmol/L的目标也是如此。欧洲医疗实践未能实现冠心病患者降低复发疾病和死亡风险的巨大潜力。
