More than half of heart patients continue smoking after hospitalisation
More than half of heart patients continue smoking after hospitalisation, according to results of the EUROASPIRE V survey presented today at EuroPrevent 2018, a European Society of Cardiology congress.1 Nearly half of obese patients have no plans for weight loss.
EUROASPIRE is a series of cross sectional surveys on cardiovascular prevention in Europe that are conducted under the ESC's EORP initiative.2 EUROASPIRE V examined cardiovascular risk factors in 8,261 patients with established coronary heart disease from 27 countries during June 2016 to September 2018. Patients were interviewed and clinically examined six months to two years (median 1.12 years) after hospitalisation for an acute coronary event or coronary revascularisation.
Nearly one in four patients (26 percent) in the study were women, the average age of all study participants was 64 years, and one-third were under 60 years old.
One year after their heart attack, more than half (55 percent) of the patients who were smokers before hospitalisation were still smoking (almost one-fifth of all study participants).
Professor Kornelia Kotseva, chair of the EUROASPIRE Steering Committee from Imperial College London, UK, said: "Smoking is still a major problem in patients who have been hospitalised for heart disease, especially in younger patients."
Some 38 percent of patients were obese (body mass index 30kg/m2 or higher), with levels ranging from 16 percent in Serbia to 47 percent in Lithuania. Of those who were obese, 45 percent had no plans for weight loss and 25 percent had never been told they had a weight problem. More than half of patients (59 percent) were centrally obese (waist circumference 88 cm or greater in women and 102 cm or greater in men).
The prevalence of high blood pressure (140/90 mmHg or above, and 140/80 mmHg or above in patients with diabetes) was 46 percent (range 31–57 percent), while 12 percent of patients had blood pressure 160/100 mmHg or above. Antihypertensive drugs were used in 78 percent of patients (range 49–83 percent), of whom 49 percent had controlled blood pressure (less than 140/90 mmHg, and less than 140/80 mmHg in patients with diabetes).
The prevalence of elevated low-density lipoprotein (LDL) cholesterol (1.8 mmol/L or higher) was 71 percent. A total of 84 percent of patients were taking lipid-lowering drugs (almost exclusively statins). Of these, only 32 percent of patients reached an LDL cholesterol target of less than 1.8 mmol/L (70 mg/dL). Most patients (93 percent) were on antiplatelet medication, 81 percent were on beta-blockers and 75 percent were on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
Some 29 percent of patients reported that they had diabetes, but only 54 percent of these patients had HbA1c less than 7 percent, meaning their diabetes was well controlled. In addition to those with known diabetes, an oral glucose tolerance test revealed that 12 percent of patients had newly detected diabetes, 18 percent had impaired glucose tolerance, and 10 percent had impaired fasting glycaemia.
Less than half (46 percent) of patients had been advised to attend cardiac rehabilitation programmes (range 0–84 percent), and only 32 percent attended at least half of the sessions. Professor Kotseva said: "Some countries do not have any programmes on secondary prevention and rehabilitation while in others they are standard practice. Most patients follow advice to attend such programmes so the challenge is to achieve wider availability and access for all patients across Europe."
Professor David A. Wood, Principal Investigator of EUROASPIRE from Imperial College London, said multidisciplinary, comprehensive prevention programmes were needed for all patients with coronary heart disease. He said: "We need multidisciplinary teams to address lifestyle, risk factor management and the effective use of cardioprotective drug therapies."