Differences in the risk profile and treatment of patients with stable angina in the Czech and Slovak Republics.
- 1 III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha
- 2 III. Interná klinika Fakultnej nemocnice akademika Dérera a Lekárska fakulta Univerzity Komenského, Bratislava, Slovenská republika
- 3 Oddělení funkčního vyšetřování, Fakultní nemocnice Brno-Bohunice, Masarykova univerzita, Brno
- 4 Servier, s. r. o., Praha, Česká republika
Introduction:
In 2001, a project called the "ATP Survey" (Angina Treatment Patterns) was carried out in seven European countries, Russia and China in an effort to obtain demographic data on patients with stable angina, to characterize current techniques of diagnosis and risk stratification, and to define current therapeutic standards. Results of the survey as obtained in the Czech Republic (CR) were published in Cor et Vasa. This paper shows the differences in the risk profiles of patients and therapeutic standards between the CR and the Slovak Republic (SR).
Method:
A total of 1,348 patients with stable angina took part in the survey (640 and 708 patients in the CR and SR, respectively). Data were collected using a physician-completed questionnaire. At the same time, each patient was given a diary to enter, for 30 days, the number and intensity of anginal attacks and nitroglycerin use. Data were analyzed using methods of descriptive statistics separately for either country and compared using a non-paired t-test for continuous variables and the P2 test for categorical variables.
Results:
On average, patients in the CR were 4 years older, their body weight was 2 kg lower (or had a BMI lower by 1 kg/m2), and their systolic and diastolic BP was 4 and 3 mm Hg lower, respectively, compared with their Slovak counterparts. Slovak patients were more often hypertensive (80.9 vs. 70.6%), but had less frequently hyperlipidemia (55.1 vs. 65.5%) and diabetes mellitus (29.2 vs. 35.9%). However, Slovak patients were found to have significantly lower mean HDL-cholesterol levels (1.18 ± 0.42 vs. 1.33 ± 0.52 mmol/L; p < 0.0001). Mean total and LDL-cholesterol as well as triglyceride levels did not differ significantly between the two countries. The clinical severity of angina was comparable in either country. The mean numbers of anginal attacks per week was 4.12 ± 5.73 in the CR and 4.33 ± 5.94 in the SR. Mean nitroglycerin (NTG) consumption was 3.42 ± 5.78 U/week in the CR and 3.11 ± 4.08 U/week in the SR. Major differences between the two countries were noted in therapy. The mean numbers of antianginal agents per patient were 2.14 and 2.60 in the CR and SR, respectively. Long-acting nitrate use was comparable in both countries (84.0 vs. 82.8%); with preference given, in the SR, to isosorbite mononitrate (56.5 vs. 48.1%) and retard NTG (19.5 vs. 10.2%), whereas isosorbide dinitrate was less popular (24.0 vs. 41.7%). In the SR, molsidomine was used twice as often compared with the CR (46.2 vs. 20.2%). While beta-blockers were also used comparably in both countries (62.0 vs. 64.4%), the range of products differed significantly as, e. g., bisoprolol was used much more often in the SR (40.8 vs. 3.6%). Calcium-channel blockers, particularly amlodipine and diltiazem, showed higher prescription rates in the SR (41.9 vs. 33.8%). Trimetazidine was used by twice as many Slovak patients compared with Czech ones (26.1 vs. 13.1%). In the SR, lipid-lowering agents were used less often (44.4 vs. 57.0%); conversely, the prescription rates for ACE inhibitors were higher (65.0 vs. 54.8%), with the range of specific products again being varied. The CR showed higher rates of invasive procedures, be they percutaneous coronary transluminal angioplasty (13.3 vs. 5.8%) or surgery (11.1 vs. 7.2%).
Conclusion:
There are significant differences between the CR and SR in the risk profile and management of patients with stable angina.
Keywords: Angina pectoris; Antianginal agents; Coronary heart disease; Risk profile
Published: March 1, 2005 Show citation