Risk factor control in secondary prevention of cardiovascular disease: results from the multi-ethnic HELIUS study.
OBJECTIVE
To evaluate the quality of contemporary secondary prevention of cardiovascular disease (CVD), and the differences between six ethnic groups in a large, observational cohort.


METHODS
We included participants with a self-reported history of CVD from the HEalthy LIfe in an Urban Setting (HELIUS) study, which investigates inequalities in health between six ethnic groups living in Amsterdam, the Netherlands. We quantified the proportions of patients who were at the preventive treatment goal according to the guidelines of the European Society of Cardiology for six risk factors: hypertension, dyslipidaemia, smoking, overweight, physical inactivity and diabetes mellitus, and the use preventive medication.


RESULTS
Of 22,165 participants, 1163 (5%) reported a history of CVD. Mean age was 54 years. Overall, 69% had a systolic blood pressure of <140 mm Hg, and 42% had a low-density lipoprotein (LDL) cholesterol of <2.5 mmol/l. Non-smoking was found in 67%. Body mass index (BMI) <25 kg/m2was found in 24%, and 54% reported adequate physical activity. The mean number of risk factors per patient was three (±1.1) out of six, and only 2% had all risk factors on target. Across the ethnic groups, non-smoking was more prevalent in the Ghanaian and Moroccan groups than in the Dutch (p < 0.001 and p = 0.001, respectively); BMI <25 kg/m2and adequate physical activity were less prevalent among all ethnic minority groups compared with the Dutch group.


CONCLUSIONS
We found large treatment gaps in secondary prevention of CVD. Ethnic differences in risk factors were found; however, strategies to improve overall risk factor management may be mandated before designing ethnic-specific strategies.
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. m.minneboo@amc.uva.nl.
M
M
Minneboo
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
S
S
Lachman
Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands.
M B
MB
Snijder
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
J T
JT
Vehmeijer
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
H T
HT
Jørstad
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
R J G
RJ
Peters
Cardiovascular disease; Ethnicity; HELIUS study; Risk factors; Secondary prevention