Treatment goal attainment for secondary prevention in coronary patients with or without diabetes mellitus : Polish multicenter study POLASPIRE

Introduction: Cardiovascular disease is still a leading cause of death in Poland and across Europe. The aim of this study was to assess the attainment of the main treatment goals for secondary cardiovascular prevention in coronary patients with or without diabetes mellitus (DM) in Poland. Material and methods: The study group included 1026 patients (65.5 ±9 y.o.; males: 72%) included at least 6 months after the index hospitalisation for myocardial infarction, unstable angina, elective percutaneous coronary intervention or coronary artery bypass surgery. The target and treatment goals were defined according to the 2016 European Society of Cardiology guidelines on cardiovascular prevention. Results: Patients with DM (n = 332; 32%) were slightly older compared to non-diabetic (n = 694) individuals (67.2 ±7 vs. 64.6 ±9 years old; p < 0.0001). The DM goal was achieved in 196 patients (60%). The rate of primary (LDL: 51% vs. 35%; p < 0.0001) and secondary (non-HDL: 56% vs. 48%; p < 0.02) goal attainment was higher in DM(+) compared to DM(–) patients. The rate of target blood pressure was lower in DM(+) than in normoglycemic patients (52% vs. 61% at < 140/90 mm Hg, p < 0.01. As expected, goal achievement of normal weight (9.5% vs. 19%; p < 0.0001) and waist circumference (7% vs. 15%; p < 0.001) was lower in diabetic patients and the rate of regular physical activity was similar (DM+ 12% vs. DM– 14%; p = ns). Finally, there was no difference in active smokers (DM+ 23% vs. DM– 22%; p = ns). Conclusions: Great majority of Polish patients in secondary prevention do not achieve treatment goals. Although lipid goals attainment is better in DM and the rate of smokers is similar, the management of all risk factors needs to be improved

Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey

Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD.Methods: Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after the hospitalization.Results: Overall, 947 patients were examined 6–18 months after hospitalization. The proportion of patientswith high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6–18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure &lt; 140/90 mmHg, LDL-C &lt; 1.8 mmol/L and glucose &lt; 7.0 mmol/L, body mass index &lt; 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled.Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational

Secondary prevention of coronary artery disease in Poland : results from the POLASPIRE survey

Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD. Methods: Fourteen departments of cardiology participated in the study. Patients (aged <= 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after the hospitalization. Results: Overall, 947 patients were examined 6-18 months after lwspitalization. The proportion of patients with high blood pressure (>= 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C >= 1.8 mmol/L) 62%, and with high fasting glucose (>= 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of atients taking an antiplatelet agent 6-18 months after hospitalization was 93%, beta-blacker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140190 mmHg, LDL-C < 1.8 mmoIlL and glucose < 7.0 mmoilL, body mass index < 25 kg/m(2)), while 179% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled. Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational

Smoking cessation in patients with established coronary artery disease: data from the POLASPIRE survey

Background: Smoking cessation in patients with coronary artery disease (CAD) is related to decreased risk of cardiovascular events. Aims: To evaluate factors related to persistent smoking in patients with established coronary artery disease. Methods: Patients aged 80 years or younger and hospitalized for acute coronary syndrome or a myocardial revascularization procedure were interviewed 6 to 18 months after the recruiting event. Medical history, smoking behavior, and exposure to environmental smoke were assessed during the interview. Self­­reported smoking status was validated by carbon monoxide in exhaled air measurement. Persistent smoking was defined as smoking at the time of interview among those who smoked during the month prior to the recruiting event. Results: We analyzed the data of 1034 patients, including 764 (73.9%) who reported smoking at any time in the past and 296 (28.6%) who smoked within 1 month before the recruiting hospitalization. At the time of the interview, the overall smoking rate was 17.2%, whereas 54.7% of patients were persistent smokers. Secondhand smoke exposure and duration of smoking were associated with lower likelihood whereas older age, high socioeconomic status, cardiac rehabilitation following a cardiovascular event, and consultation with a cardiologist were associated with higher likelihood of smoking cessation. Conclusions: Over half of all smokers hospitalized for CAD are still smoking 6 to 18 months after discharge. Older age, secondhand smoking, low socioeconomic status, lack of consultation with a cardiologist, and cardiac rehabilitation following hospitalization were related to persistent smoking. Our findings may help develop strategies aimed at assisting smoking cessation in patients with CAD

Prevalence and control of arterial hypertension in Mazovian men and women enrolled in the POLASPIRE study

Wstęp. Nadciśnienie tętnicze (AH) jest jednym z głównych, modyfikowalnych czynników ryzyka chorób układu sercowo-naczyniowego, który zwiększa zachorowalność i umieralność z powodu tych schorzeń.Celem pracy była ocena rozpowszechnienia oraz kontrola leczenia AH u kobiet i mężczyzn z chorobą wieńcową.Materiał i metody. Badanie przeprowadzono w grupie chorych włączonych do badania POLASPIRE w województwie mazowieckim. Definicje czynników ryzyka i celów terapeutycznych oparto na wytycznych Europejskiego Towarzystwa Kardiologicznego z 2016 roku dotyczących prewencji sercowo-naczyniowej.Wyniki. AH rozpoznano u 88% kobiet i 81% mężczyzn (p = 0,56) włączonych do analizy. W grupie chorych z AH kobiety były starsze niż mężczyźni (p &lt; 0,001). Częstości rozpoznawania cukrzycy (p = 1,00), dyslipidemii (p = 0,42) oraz otyłości (p = 0,47) nie różniły się istotnie pomiędzy grupami. U kobiet częściej stwierdzano przebyty udar mózgu (p &lt; 0,001), obniżony współczynnik filtarcji kłębuszkowej (p &lt; 0,001), podwyższone wartości cholesterolu frakcji lipoprotein o niskiej gęstości (p = 0,029), cholesterolu niezwiązanego z lipoproteinami o wysokiej gęstości (p = 0,022) oraz cechy dysfunkcji rozkurczowej lewej komory (p = 0,006). Docelowych wartości ciśnienia tętniczego nie osiągnęło 51% kobiet i 50% mężczyzn (p = 1,00). Nie stwierdzono istotnych różnic między grupami w zakresie farmakoterapii AH.Wnioski. Rozpowszechnienie AH u osób z chorobą wieńcową jest duże. Wysoki odsetek chorych nie osiąga zalecanychwartości ciśnienia tętniczego. Konieczne jest podjęcie działań służących poprawie skuteczności leczenia hipotensyjnego.Introduction. Arterial hypertension (AH) is one of the major modifiable risk factors for cardiovascular disease, which increases cardiovascular morbidity and mortality. The aim of this study was to evaluate AH prevalence and treatment control in men and women with coronary artery disease. Material and methods. The study included patients enrolled in the POLASPIRE trial in the Mazovian region. Definitions of risk factors and therapeutic targets were based on the 2016 European Society of Cardiology guidelines for cardiovascular prevention. Results. AH was diagnosed in 88% of women and 81% of men (p = 0.56). Among AH patients, women were older than men (p < 0.001). There were no statistically significant gender-related differences in the prevalence of diabetes mellitus (p = 1.00), dyslipidemia (p = 0.42), and obesity (p = 0.47). Women were more likely to have a history of stroke (p < 0.001), reduced glomerular filtration rate values (p < 0.001), elevated low-density lipoprotein cholesterol (p = 0.029), and non-high-density lipoprotein cholesterol levels (p = 0.022) as well as echocardiographic features of left ventricular diastolic dysfunction (p = 0.006). 51% of women and 50% of men (p = 1.00) did not achieve blood pressure targets. There were no significant differences between groups regarding pharmacotherapy for AH. Conclusions. The prevalence of AH in patients with coronary artery disease is high. A significant percentage of men and women do not achieve recommended blood pressure values. There is a need to improve the effectiveness of antihypertensive treatment

Undiagnosed diabetes and prediabetes in patients with chronic coronary syndromes : an alarming public health issue

Dysglycemia is a public health challenge for the coming decades, especially in patients with chronic coronary syndromes (CCS). We want to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes, as well as identify factors associated with the development of dysglycaemia in patients with CCS. In total, 1233 study participants (mean age 69 ± 9 years), who, between 6 and 18 months earlier were hospitalized for acute coronary syndrome or elective revascularization, were examined (71.4% men). The diagnosis of DM, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) have been made according to World Health Organization (WHO) criteria. Based on the oral glucose tolerance test (OGTT) results, DM has been newly diagnosed in 28 (5.1%, mean age 69.9 ± 8.4 years) patients, 75% were male (n = 21). Prediabetes has been observed in 395 (72.3%) cases. IFG was found in 234 (42.9%) subjects, 161 (29.5%) individuals had IGT. According to multinomial logistic regression, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) should be considered when assessing risk of development of dysglycaemia after discharge from the hospital. Among people with previously diagnosed DM, a significantly higher percentage were willing to change their lifestyles after the index event compared to other patients. Patients with chronic coronary syndromes suffer a very high frequency of dysglycaemia. Most patients with chronic coronary syndromes, especially those with high BMI or low HDL-C, should be considered for screening for dysglycemia using OGTT within the first year after hospitalization. A higher percentage of patients who were aware of their diabetic status changed their lifestyles, which added the benefit of timely diagnosis and treatment of diabetes