EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries.
OBJECTIVE
To determine whether the 2003 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been followed in general practice.


METHODS
Cross-sectional survey.


METHODS
The EUROASPIRE survey was carried out in 2006-2007 in 66 general practices in 12 European countries. Patients without a history of coronary or other atherosclerotic disease either started on antihypertensive and/or lipid-lowering and/or antidiabetes treatments were identified retrospectively, interviewed and examined at least 6 months after the start of medication.


RESULTS
Four thousand, three hundred and sixty-six high-risk individuals (57.7% females) were interviewed (participation rate 76.7%). Overall, 16.9% smoked cigarettes, 43.5% had body mass index ≥30 kg/m, 70.8% had blood pressure ≥140/90 mmHg (≥130/80 in people with diabetes mellitus), 66.4% had total cholesterol ≥5.0 mmol/l (≥4.5 mmol/l in people with diabetes) and 30.2% reported a history of diabetes. The risk factor control was very poor, with only 26.3% of patients using antihypertensive medication achieving the blood pressure goal, 30.6% of patients on lipid-lowering medication achieving the total cholesterol goal and 39.9% of patients with self-reported diabetes having haemoglobin A1c ≤6.1%. The use of blood pressure-lowering medication in people with hypertension was: β-blockers 34.1%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers 60.8%, calcium channel blockers 26.3%, diuretics 36.9%. Statins were prescribed in 47.0% of people with hypercholesterolemia. About 22.0% of all patients were on aspirin or other antiplatelet medication.


CONCLUSIONS
The EUROASPIRE III survey in general practice shows that the lifestyle of people being treated as high cardiovascular risk is a major cause of concern with persistent smoking and high prevalence of both obesity and central obesity. Blood pressure, lipid and glucose control are completely inadequate with most patients not achieving the targets defined in the prevention guidelines. Primary prevention needs a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by general practitioners, nurses and other allied health professionals, and a health care system which invests in prevention.
Kotseva
Kornelia
K
Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. k.kotseva@imperial.ac.uk
Wood
David
D
De Backer
Guy
G
De Bacquer
Dirk
D
Pyörälä
Kalevi
K
Reiner
Zeljko
Z
Keil
Ulrich
U
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005060:Europe; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D016896:Treatment Outcome; D015431:Weight Loss
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents