Prevention of cardiovascular disease and diabetes on a population level

Background: Cardiovascular disease and diabetes are responsible for just over half of the global mortality, and these diseases are expected to increase. The upsurge is due to increased longevity and a westernisation of the global lifestyle. Preventive efforts have proven effective and are believed to be the only way to curb the rapid increase of these diseases. Still the implementations of preventive measures are reported as underused. Aims: To study prevention by 1. Investigating the perception of key policymakers on cardiovascular disease 2. Examining if screening for diabetes online is feasible using FINDRISC 3. Assessing management of patients with coronary artery disease and diabetes 4. Determining the best screening test for dysglycaemia in patients with coronary artery disease Policymakers’ perception of cardiovascular disease Policymakers in Europe agreed that national patterns of cardiovascular disease and its prevention are far from satisfactory. A similar rating of the perceived proximity to a specific target in two countries did not necessarily reflect a similar national situation when compared to available statistics on the actual situation. Policymakers had diverging opinions on what actions to take and what obstacles to overcome to improve population health.Feasibility of using FINDRISC as an online questionnaire It was feasible to incorporate a diabetes risk score such as FINDRISC in an online survey. A reasonable response rate was achieved and a group that could benefit from preventive intervention programs was identified. Management of patients with coronary artery disease and diabetes A large proportion of the patients are far from guideline recommended evidence based treatment targets for blood pressure, LDL-cholesterol and HbA1c. A potential reason is a consistent, relatively low combined use of four selected cardioprotective drug therapies and/or lack of dose titration. There was, however, some improvement over time. Screening for dysglycaemia in patients with coronary artery disease Screening by means of an oral glucose tolerance test (OGTT) identified the largest number of patients with undetected diabetes. The overlap in case-detection between fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) and HbA1c was small. Screening with HbA1c alone would have left 83% of those with diabetes undetected. The total proportion of patients identified with diabetes and other forms of dysglycaemia varied from 90% using the American Diabetes Association’s criteria for FPG + HbA1c, which may be an overestimate, to 73% using WHO criteria for OGTT = FPG + 2hPG, which may be more realistic. Conclusion: Creating a coherent knowledge base and action agenda regarding prevention among key policy- makers should be given high priority in future population based prevention programmes. The online questionnaire FINDRISC is a feasible way to identify high-risk individuals as well as risk typing populations. Despite some improvement, patients with coronary artery disease and diabetes are not managed according to best available knowledge. Efforts to improve this are needed to improve their still dismal prognosis. An oral glucose tolerance test has the best capacity to screen-detect dysglycaemia in patients with coronary artery disease

Pay for disease or invest in health?

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Hjärt–kärlsjukdom är den ledande enskilda orsaken till död och ohälsa i vår del av världen. Den medicinska och ekonomiska bördan av dessa sjukdomar är enorm. Även om nyinsjuknandet och dödligheten i tex hjärtinfarkt har minskat i vårt land, liksom i många europeiska länder, är antalet människor som insjuknar i förtid och som lever med resttillstånd efter olika hjärt–kärlsjukdomar snarast i stigande, vilket sammanhänger med att vi lever längre och att överlevnaden efter hjärtinfarkt och slaganfall har ökat. Största delen av dessa sjukdomar liksom av andra kroniska, icke-smittsamma sjukdomar (cancer, lungsjukdom, diabetes osv) sammanhänger med påverkbara, livsstilsrelaterade riskfaktorer. Hälsosamma val, dvs bra mat, fysisk aktivitet, frånvaro av tobaksbruk och undvikande av överkonsumtion av alkohol, kan förhindra eller i vart fall fördröja ett insjuknande. Den medicinska professionen bör ta som sin uppgift att i samverkan med politiker, hälsovårdsadministratörer och medier upplysa allmänheten om dessa enkla fakta. Genom kloka policybeslut kan man underlätta för befolkningen att göra hälsosamma val redan från de tidiga barnaåren och genom hela livscykeln

Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. ----- METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. ----- RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of 9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. ----- CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease

Pay for disease or invest in health?

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Hjärt–kärlsjukdom är den ledande enskilda orsaken till död och ohälsa i vår del av världen. Den medicinska och ekonomiska bördan av dessa sjukdomar är enorm. Även om nyinsjuknandet och dödligheten i tex hjärtinfarkt har minskat i vårt land, liksom i många europeiska länder, är antalet människor som insjuknar i förtid och som lever med resttillstånd efter olika hjärt–kärlsjukdomar snarast i stigande, vilket sammanhänger med att vi lever längre och att överlevnaden efter hjärtinfarkt och slaganfall har ökat. Största delen av dessa sjukdomar liksom av andra kroniska, icke-smittsamma sjukdomar (cancer, lungsjukdom, diabetes osv) sammanhänger med påverkbara, livsstilsrelaterade riskfaktorer. Hälsosamma val, dvs bra mat, fysisk aktivitet, frånvaro av tobaksbruk och undvikande av överkonsumtion av alkohol, kan förhindra eller i vart fall fördröja ett insjuknande. Den medicinska professionen bör ta som sin uppgift att i samverkan med politiker, hälsovårdsadministratörer och medier upplysa allmänheten om dessa enkla fakta. Genom kloka policybeslut kan man underlätta för befolkningen att göra hälsosamma val redan från de tidiga barnaåren och genom hela livscykeln

Accuracy of a Simplified Glucose Measurement Device-The HemoCue Glucose 201RT.

Easily available, accurate glucose recordings are important when screening for and managing people with diabetes. The photometric HemoCue(®) (Ängelholm, Sweden) Glucose 201+ system, which delivers lab-comparable glucose recordings, has the drawback that its microcuvettes must be delivered and stored at 4-8°C. A newly developed system, HemoCue Glucose 201RT, has microcuvettes that can be stored at room temperature

Achievement of lifestyle, blood pressure, lipids and diabetes goals for primary prevention of cardiovascular disease across Europe: results of EUROASPIRE IV survey

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Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets?: a report from the EuroAspire III cross-sectional study

Purpose: The aim was to investigate the use of cardioprotective drug therapies (aspirin or other antiplatelet agents, -blockade, renin-angiotensin-aldosterone-system-blockade (RAAS-blockade) and statins) and treatment targets achieved in a large cohort of patients with established coronary artery disease and diabetes across Europe. Methods and results: EUROASPIRE III is an observational cross-sectional study of stable coronary artery disease patients aged 18-80 years from 76 centres in 22 European countries conducted in 2006-2007. The glycaemic status (prevalent, incident or no diabetes), the guideline treatment targets achieved and the use of pharmacotherapies were assessed at one visit 6-36 months after the index event. Of all 6588 patients investigated (women 25%), 4295 (65%) had no diabetes, 752 (11%) had incident diabetes and 1541 (23%) had prevalent diabetes. All four drugs were used in 44% of the patients with no diabetes, 51% with incident diabetes and 50% with prevalent diabetes respectively. Individual prescriptions for patients with no, incident and prevalent diabetes were respectively: aspirin or other antiplatelet agents 91, 93, and 91%; -blockers: 81, 84, and 79%; RAAS-blockers: 77, 76, and 68%; statins: 80, 80, and 79%. The proportion of patients with coronary artery disease and prevalent diabetes reaching the treatment targets were 20% for blood pressure, 53% for low density lipoprotein cholesterol (LDL-cholesterol) and 22% for haemoglobin A1c (HbA1c). Conclusion: This European study demonstrates a low use of cardioprotective drug therapies among patients with a combination of coronary artery disease and diabetes, which will be contributing to the poor achievement of risk factor treatment targets for cardiovascular prevention

Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV, a survey from the European Society of Cardiology

Aims: Three methods are used to identify dysglycaemia: fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG) from the oral glucose tolerance test (OGTT), and glycated haemoglobin A1c (HbA1c). The aim was to describe the yield and concordance of FPG, HbA1c, and 2hPG alone, or in combination, to identify dysglycaemia in patients with coronary artery disease. Methods and results: In EUROASPIRE IV, a cross-sectional survey of patients aged 18-80 years with coronary artery disease in 24 European countries, 4004 patients with no reported history of diabetes had FPG, 2hPG, and HbA1c measured. All participants were divided into different glycaemic categories according to the ADA and WHO criteria for dysglycaemia. Using all screening tests together, 1158 (29%) had undetected diabetes. Out of them, the proportion identified by FPG was 75%, by 2hPG 40%, by HbA1c 17%, by FPG + HbA1c 81%, and by OGTT(=FPG + 2hPG) 96%. Only 7% were detected by all three methods FPG, 2hPG, and HbA1c. The ADA criteria (FPG + HbA1c) identified 90% of the population as having dysglycaemia compared with 73% with the WHO criteria (OGTT =FPG + 2hPG). Screening according to the ADA criteria for FPG + HbA1c identified 2643 (66%) as having a 'high risk for diabetes', while the WHO criteria for FPG + 2hPG identified 1829 patients (46%). Conclusion: In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients