Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

Background: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods: The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed 6 months after the start of medication. Results: A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index 30 kg/m2 ) and 63.8% centrally obese (waist circumference 88 cm for women, 102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion: The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial

Original paper Mildronate improves the exercise tolerance in patients with stable angina: results of a long term clinical trial

Summary The objective of the study was to assess the efficacy and safety of the treatment with Mildronate (1 g/day) in combination with a standard therapy for the exercise tolerance of patients with stable angina pectoris. Design and methods: The study was a prospective, randomized, double-blind, placebo controlled phase III trial with two treatment groups. The study was carried out in 37 medical centres in 4 countries (Latvia, Lithuania, Russian Federation and Ukraine). The study group comprised 317 patients with chronic coronary heart disease (CHD, II-III according to the classification of the Canadian Cardiovascular Society (CCS)) who had ischemia as the limiting factor in the exercise test. The treatment period lasted for 12 months. Results: The mean value of the change in the total exercise time in the mildronate group at month 12 was 55.05 ± 88.01 seconds (sec), while the placebo patients had the mean value 0.79 ± 68.21 sec. The difference between the treatment groups was highly significant (p &lt; 0.001). The mean value of the change at the maximum achieved load in the mildronate group was 7.78 ± 13.90 W, while the placebo patients had the mean value 0.10 ± 12.40 W. The difference between the treatment groups was highly significant (p &lt; 0.001). At month 12 the time to deviation of ST-segment to 1 mm at least in the mildronate group increased from 425.63 ± 160.97 sec to 483.83 ± 193.99 sec, whereas a decrease with respect to the visit 6 was observed in the placebo group: from 436.76 ± 177.66 to 425.98 ± 159.12 sec. The difference between the treatment groups at month 12 was significant (p = 0.01). At month 12 the time to the onset of angina in the mildronate group increased from 460.50 ± 155.51 sec to 490.50 ± 207.27 sec, whereas a slight decrease was observed in the placebo group. The difference between the treatment groups at month 12 was significant (p = 0.044). Conclusions: This study has revealed the superiority of the treatment with Mildronate (1 g/day) in combination with a standard therapy for the exercise tolerance of patients with stable angina pectoris over the treatment with placebo in combination with a standard therapy. Seminars in Cardiovascular Medicine 2010; 16:

Relationships between body mass index, cardiovascular mortality, and risk factors: a report from the SCORE investigators

Background: Although cardiovascular disease (CVD) is the biggest global cause of death, CVD mortality is falling in developed countries. There is concern that this trend may be offset by increasing levels of obesity. Design: We used the Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships between body mass index (BMI), conventional risk factors and CVD mortality. Methods: The SCORE data set comprises data from 12 European cohort studies. The relationship between BMI and CVD mortality was examined in each BMI category using univariable and multivariable (Cox) analyses. The SCORE population was also divided into gender and age strata: under 40, 40-49, 50-59, and over 60. The rate of CVD mortality in each BMI category was calculated within each gender and age stratum. Relationships between BMI and other CVD risk factors were also examined. Results: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders. Each 5-unit increase in BMI was associated with an increase in CVD mortality of 34% in men and 29% in women. The hazard ratios remained significant when adjusted for age, self-reported smoking status, total cholesterol, and systolic blood pressure (SBP). On additional adjustment for diabetes and high-density lipoprotein cholesterol (HDL), the association between BMI and CVD mortality did not persist. In all age groups except those over 60 there were significant relationships between increased BMI and CVD mortality. In the over-60 age group the only significant relationships with mortality were in underweight and severely overweight women and mildly obese men. After adjustment for age, each 1-unit increase in BMI was associated with a 1.14mmHg increase in SBP, 0.055 mmol/l increase in total cholesterol, and a 0.024 mmol/l decrease in HDL in men. Figures were slightly lower in women. Conclusions: Overall, overweight and obesity relate to CVD mortality in a strong and graded manner. The effects are greater in women and markedly so in younger persons. It is likely that a substantial part of the BMI-associated risk of CVD mortality is mediated through other known CVD risk factors. This increases the public health importance of BMI as both a simple indicator and mediator of CVD risk

Cost-effectiveness of optimized adherence to prevention guidelines in European patients with coronary heart disease : results from the EUROASPIRE IV survey

Background: This study aims to assess the cost-effectiveness of optimized guideline adherence in patients with a history of coronary heart disease. Methods: An individual-based decision tree model was developed using the SMART risk score tool which estimates the 10-year risk for recurrent vascular events in patients with manifest cardiovascular disease (CVD). Analyses were based on the EUROASPIRE IV survey. Outcomes were expressed as an incremental cost-effectiveness ratio (ICER). Results: Data from 4663 patients from 13 European countries were included in the analyses. The mean estimated 10-year risk for a recurrent vascular event decreased from 20.13% to 18.61% after optimized guideline adherence. Overall, an ICER of 52,968€/QALY was calculated. The ICER lowered to 29,093€/QALY when only considering high-risk patients (≥20%) with decreasing ICERs in higher risk patients. Also, a dose-response relationship was seen with lower ICERs in older patients and in those patients with higher risk reductions. A less stringent LDL target (<2.5 mmol/L vs. <1.8 mmol/L) lowered the ICER to 32,591€/QALY and intensifying cholesterol treatment in high-risk patients (≥20%) instead of high-cholesterol patients lowered the ICER to 28,064€/QALY. An alternative method, applying risk reductions to the CVD events instead of applying risk reductions to the risk factors lowered the ICER to 31,509€/QALY. Conclusion: Depending on the method used better or worse ICERs were found. In addition, optimized guidelines adherence is more cost-effective in higher risk patients, in patients with higher risk reductions and when using a less strict LDL-C target. Current analyses advice to maximize guidelines adherence in particular patient subgroups

AMS :: ATX August 2014 Blog Archive 

Contents: Grad Research: Carrie Andersen publishes article on drones and Call of Duty in Surveillance and Society -- Faculty Research: Janet Davis wins Constance Rourke Prize for Best Essay in American Quarterly -- Grad Research: Eric Covey’s Intro AMS course creates photography Tumblr -- Welcome back from AMSAMS :: ATX is a blog dedicated to representing the many activities and interests of the department of American Studies at The University of Texas at Austin. Together with the department’s Twitter feed, this blog exists to serve the AMS and Austin communities by acting as a hub for up-to-date information on events and opportunities at UT and beyond.American Studie

The role of European national journals in education.

[No abstract available