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

Abstract Introduction The main objectives of cardiovascular prevention are to maintain risk factor management through lifestyle changes 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 the 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 the 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% had low physical activity, 75% had raised blood pressure (≥130/80 mmHg, according to the 2007 guidelines), 39% had elevated LDL-cholesterol (≥2.5 mmol/l), and 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 angiotensin receptor blockers (ARBs), and 93% with statins. Only a minority of the patients followed the non-pharmacologic secondary prevention recommendations. Conclusion Among coronary patients, prevalence of overweight, obesity, and diabetes increased. Although pharmacotherapy is used in a majority of secondary prevention in patients, the recommended levels of blood pressure, lipid, and glucose metabolism are largely not achieved. Also, implementation of non-pharmacologic interventions of lifestyle factors remains unsatisfactory.