Prevalence and management of CVD risk factors in European patients
In 2015, just under 11.3 million Europeans had CVD leading to 4 million deaths and costing the EU economy €210 billion a year [1,2]. Most of these deaths were accelerated due to poor management of CVD risk factors such as weight, smoking and exercise.
A team from The European Society of Cardiology (ESC) led by Dr. Kornelia Kotseva evaluated guideline implementation for patients with CVD. To do this, 16,426 CVD patients from 24 European countries were surveyed 6 months following a cardiovascular event to identify risk factors, patient lifestyle, and therapeutic management. This study aimed to objectively assess clinicians’ implementation of scientific knowledge.
Surveyed patients had their obesity status measured via BMI (≥30 kg/m^2) alongside their waist circumference (F: M ≥88: ≥102 cm). Smokers could self-report as smokers or persistent smokers (smoking 1 month before a cardiovascular event). Additionally, patients had their breath CO and blood pressure measured to identify their smoking and hypertension status. Venous fasting blood samples were also taken measuring cholesterol (triglycerides, LDL & HDL) and HbA1c levels. Finally, patients were interviewed to assess physical activity levels, advising vigorous activity ≥20 minutes per week. Patients who were not interviewed had their discharge letters and medical records reviewed to retrieve data.
Three-quarters (73.55%) of CVD patients were men. Figure 1 shows the prevalence of risk factors from interviewed CVD patients. From this data, we see that healthcare professionals (HCPs) need to tackle many risk factors including the number of patients still overweight, by increasing their weekly exercise. HCPs also need to reduce lipid levels amongst CVD patients
This study has many implications for the way how clinicians across Europe manage CVD. A high proportion of patients are not meeting lifestyle, risk factor or therapeutic targets set in the JES guidelines which need to be addressed by HCPs. Studies have shown that cutting smoking reduces an individual’s risk of coronary-related mortality by 36–46% [4,5]. Despite that, less than 1 in 5 were advised to attend a smoking cessation clinic (18.1%) or prescribed nicotine replacement therapy (NRT) (14.4%) or varenicline (3.1%) — a drug shown to lead to abstinence in 51% of smokers within 16 weeks [6].
Other studies have shown the benefit of an active lifestyle alongside a good diet can bring to CVD patients. Not only have diet and exercise been shown to improve patient blood pressure, cholesterol levels, and glucose control [7,8,9], but it has also been shown to reduce patient risk of cardiovascular events [10]. However, 81.5% of surveyed patients had a BMI above 25kg/m^2. HCPs should provide patients with professional advice to improve their diet and physical activity.
Regarding therapeutic targets, HCPs should follow the JES guidelines for cardioprotective managing their cholesterol, blood pressure, and diabetes. The study also mentioned that patients could miss biochemistry targets is due to a failure of Drs. not up-titrating therapeutic doses or beginning combination therapy. HCPs should also be reminded to engage with patients regarding medication to improve adherence and health outcomes [11].
HCPs may already be aware of guidelines and recommended practices. However, more must be done to inform patients of their health status and optimise their management plan.
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