Cor Vasa 2014, 56(2):e105-e112 | DOI: 10.1016/j.crvasa.2014.02.012

State of secondary prevention in Czech coronary patients in the EUROASPIRE IV study

Jan Bruthans^a,b,c,*, Otto Mayer jr.^b, Markéta Galovcová^c, Jitka Seidlerová^b, Jiří Bělohoubek^c, Katarína Timoracká^b, Petra Vagovičová^b, Věra Adámková^c, Jiří Vaněk^b, Jan Filipovský^b, Renata Cífková^a

^a Centrum kardiovaskulární prevence, 1. lékařská fakulta Univerzity Karlovy a Thomayerova nemocnice, Praha, Česká republika

^b Centrum preventivní kardiologie, II. interní klinika, Lékařská fakulta Plzeň, Univerzita Karlova v Praze a Fakultní nemocnice Plzeň, Plzeň, Česká republika

^c Pracoviště preventivní kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction: The main objectives of cardiovascular prevention are, through lifestyle changes, risk factor management and use of cardioprotective medicines to reduce morbidity and mortality, and to improve quality of life.

Objectives: To determine, in patients with coronary heart disease (CHD), whether the treatment goals, as defined by current European guidelines on secondary prevention are implemented in clinical practice.

Methods: A total of 650 consecutive patients, men and women aged ≤ 80 years when hospitalized for any of following first or recurrent discharge diagnoses or treatments for CHD were retrospectively identified from hospital records: (i) coronary artery bypass grafting (CABG), (ii) percutaneous transluminal coronary angioplasty (PTCA), (iii) acute myocardial infarction (AMI), and ( iv) acute myocardial ischemia. The starting date for identification was not less than 6 months and not more than 3 years prior to the expected date of the study interview. Data collection was based on a review of medical records and the interview.

Results: In total, 493 respondents were interviewed. Among them, 17% were smokers, 42% were obese, 86% were overweight or obese, 69% had central obesity, 71% low physical activity. 75% had raised blood pressure (≥ 130/80 mmHg, according to 2007 guidelines) 39% had elevated LDL-cholesterol (≥ 2,5 mmol/l), 48%, had overt diabetes (declared diabetes treatment or fasting glucose > 7,0 mmol/l). At interview, 92% of patients were treated with aspirin or other antiplatelets, 85% with beta-blockers, 82% with ACE inhibitors or ARBs, 93% with statins. Only a minority of patients followed the non-pharmacologic secondary prevention recommendations.

Conclusion: Among coronary patients prevalence of overweight, obesity and prevalence of diabetes increased. Pharmacotherapy is used in majority of secondary prevention patients, but recommended levels of blood pressure, lipid and glucose metabolism are in major part not achieved. Also implementation of non pharmacologic interventions of life style factors remains unsatisfactory.

Keywords: Coronary heart disease; EUROASPIRE IV; Guidelines; Secondary prevention

Received: December 13, 2013; Revised: February 20, 2014; Accepted: February 26, 2014; Published: April 1, 2014  Show citation