8 research outputs found
Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population
The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA
indexes may constitute good screening methods.
Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention
and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins, and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum
value of Youden’s J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients
Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries
De Backer, G., Jankowski, P., Kotseva, K., Mirrakhimov, E., Reiner, Ž., Rydén, L., Tokgözoğlu, L., Wood, D., De Bacquer, D., EUROASPIRE V collaborators, Writing Committee, Scientific Steering/ Executive Committee, Coordinating centre, Diabetes centre, Data management centre, Statistical analysis centre, Central laboratory, & Study centres, organisations, investigators and other research personnel (National Co-ordinators in each country are indicated by asterisk (2019). Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis, 285, 135–146. https://doi.org/10.1016/j.atherosclerosis.2019.03.014
Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well
European guidelines on the management of dyslipidaemias are implemented in coronary patients.
Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from
130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a
coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into
three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no
LLT.
Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital
discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been
started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity,
intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the
cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or
moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes.
Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal
management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to
the need of the individual patient
Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients: Findings from the ESC-EORP EUROASPIRE V survey
Background and aims: Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality
worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing
cause of coronary heart disease (CHD) is also most significant. We aimed to describe alcohol consumption
patterns across European regions and adherence to the current guidelines in patients with a recent CHD event.
Methods: The ESC-EORP survey (EUROASPIRE V) has been conducted in 2016–2017 at 131 centers in 27 European countries in 7350 patients with a recent CHD. Median alcohol consumption, as well as the proportion of
abstainers and excessive drinkers (i.e. >70 g/week for women and >140 for men, as recommended by the
European guidelines on cardiovascular prevention), was calculated for each region. To assess adherence to
guidelines, proportions of participants who were advised to reduce excessive alcohol consumption and participants who were incorrectly not advised were calculated per region.
Results: Mean age was 64 years (SD: 9.5), 75% were male. Abstention rates were 53% in males and 77% in females, whereas excessive drinking was reported by 9% and 5% of them, respectively. Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% were incorrectly not advised,
however, this percentage differed per region (range: 1%–9%). In regions where alcohol consumption was
highest, participants were less often advised to reduce their consumption.
Conclusion: In this EUROASPIRE V survey, the majority of CHD patients adhere to the current drinking guidelines, but substantial heterogeneity exists between European regions
Measures of insulin resistance as a screening tool for dysglycemia in patients with coronary artery disease : a report from the EUROASPIRE V population
OBJECTIVE
The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods.
RESEARCH DESIGN AND METHODS
Insulin, C-peptide, glycated hemoglobin A lc , and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins), and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden's J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients.
RESULTS
Of 3,534 patients with CAD (mean age 63 years; 25% women), 41% had dysglycemia. Mean insulin, C-peptide, and HOMA indexes were significantly higher in patients with versus without newly detected dysglycemia (all P < 0.0001). Sensitivity and specificity of the three HOMA indexes for the diagnosis of dysglycemia were low, but their correlation with BMI and waist circumference was strong.
CONCLUSIONS
Screening for dysglycemia in patients with CAD by HOMA-IR, HOMA2-ins, and HOMA2-Cpep had insufficient diagnostic performance to detect dysglycemia with reference to the yield of an OGTT, which should still be prioritized despite its practical drawbacks
Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry.
The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice.
A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries.
Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later.
A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m <sup>2</sup> ), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%.
A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events
Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries
WOS: 000468732700018PubMed ID: 31054483Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.ESC - EORP; AmgenAmgen; Eli LillyEli Lilly; PfizerPfizer; SanofiSanofi-Aventis; Ferrer; Novo NordiskNovo NordiskThe EUROASPIRE V survey was carried out under the auspices of the ESC - EORP. Since the start of EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript
Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries
Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V
survey is to determine how well European guidelines on the management of
dyslipidaemias are implemented in coronary patients.
Methods: Standardized methods were used by trained technicians to
collect information on 7824 patients from 130 centers in 27 countries,
from the medical records and at a visit at least 6 months after
hospitalization for a coronary event. All lipid measurements were
performed in one central laboratory. Patients were divided into three
groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or
moderate-intensity LLT and on no LLT.
Results: At the time of the visit, almost half of the patients were on a
high-intensity LLT. Between hospital discharge and the visit, LLT had
been reduced in intensity or interrupted in 20.8\% of the patients and
had been started or increased in intensity in 11.7\%. In those who had
interrupted LLT or had reduced the intensity, intolerance to LLT and the
advice of their physician were reported as the reason why in 15.8 and
36.8\% of the cases, respectively. LDL-C control was better in those on
a high-intensity LLT compared to those on low or moderate intensity LLT.
LDL-C control was better in men than women and in patients with
self-reported diabetes.
Conclusions: The results of the EUROASPIRE V survey show that most
coronary patients have a less than optimal management of LDL-C. More
professional strategies are needed, aiming at lifestyle changes and LLT
adapted to the need of the individual patient