Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. EUROASPIRE I and II Group. European Action on Secondary Prevention by Intervention to Reduce Events.

BACKGROUND

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.

METHODS

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.

FINDINGS

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.

INTERPRETATION

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.