|Year : 2019 | Volume
| Issue : 1 | Page : 81-82
The EUROASPIRE IV study: Time to program the programs
Sandeep Sachdeva1, Mohd. Atif Khan2, Malay Shukla3
1 Epidemiologist Cum Lecturer, Department of Community Medicine, Sn Medical College and Associate Analyst Epidemiologist, Global Data, London, Uk
2 Resident, Department of Pediatrics, Jn Medical College, Aligarh Muslim University, Aligarh, Up, India
3 Consultant Cardiologist, Canadian Health Services, Canada
|Date of Submission||18-May-2019|
|Date of Acceptance||16-Jun-2019|
|Date of Web Publication||22-Oct-2019|
Dr. Sandeep Sachdeva
43, Ravenswood Avenue, Ipswich, Suffolk, IP3 9GG
Source of Support: None, Conflict of Interest: None
Background: Morbidity and mortality due to cardiovascular diseases (CVDs) have constantly been on an upsurge both in developed and developing countries despite constant efforts toward preventive, curative, and rehabilitative measures instituted worldwide.
Methods: The European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) studies ranging from phases I to IV have emerged as a promising endeavor aimed at deciphering the unmet need(s) toward primordial and primary prevention targeting CVDs. The different phases of this study were analysed and deduced to draw conclusions.
Observations: Whereas drug treatment and secondary preventive measures have found better population acceptance, lifestyle and dietary modifications have taken a backseat, potentially modifiable for the better if primary care physicians are better sensitized and trained towards appropriate counseling of patients as they are the first contact health resource persons.
Conclusion: There is a need for integration of preventive cardiology services into the primary health care systems of countries.
Keywords: Cardiovascular diseases, EUROASPIRE IV, prevention
|How to cite this article:|
Sachdeva S, Khan MA, Shukla M. The EUROASPIRE IV study: Time to program the programs. Nig J Cardiol 2019;16:81-2
A staggering number of over 4 million deaths is attributed to coronary heart disease annually. Despite essentially similar epidemiological and environmental determinants, large geographical inequalities are reported among individual European countries.
The primary objectives of cardiovascular disease (CVD) prevention are to mitigate associated mortality and morbidity and enhance longevity with an acceptable quality of life. It has been well researched that a multitude of risk factors including smoking, lifestyle interventions, diet and exercise, hypertension (adequate treatment/compliance), diabetes, and preemptive administration of drug therapies among “at risk” population have a significant role to play in the natural history of disease.
Secondary prevention modalities have since long been explored as potential measures toward the same, and their validity has paved the way for the inception of the four EUROASPIRE surveys (I to IV) commencing in the mid-1990s through early last decade. These surveys aimed at the evaluation of adherence of the Joint European Societies (JES) guidelines on CVD prevention.,
The EUROASPIRE IV survey identifies risk factors in coronary patients, describes and compares lifestyle changes among the study population through previous surveys, and establishes consensus on the clinical implications of the study results with emphasis on future strategies.
A total of 6187 patients (18–80 years) from 24 European countries with coronary artery disease and previously known diabetes mellitus were recruited over the study duration of 2012–2013. The study population were investigated and interviewed to establish a comparison between their actual risk factor controls with that recommended by the JEC.
The results of the EUROASPIRE study did not, however, depict a significant impact of the JES guidelines. Of note is the inference that lifestyle changes recommended by the JEC have assumed a back seat and largely condoned by primary caregivers and patients alike in comparison to pharmacotherapy [Table 1] and [Table 2] though compliance with the latter has also been far from satisfactory.
|Table 1: Prevalence of smoking, persistent smoking, overweight, obesity, abdominal overweight, and central obesity by gender at the time of study|
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|Table 2: Prevalence (%) of elevated blood pressure, raised low-density lipoprotein cholesterol, and self-reported diabetes mellitus by sex at the interview|
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Also remarkable is that whereas pertinent endeavors have successfully been effected toward primordial and primary prevention of CVDs, evidence-based secondary preventive measures have largely remained underharnessed.
The risk factors for CVDs are intercalated, and their holistic redressal is temporally and scientifically feasible alike among patients with known CVDs and the “at risk” population.
This makes a case for devising a meticulous and planned strategy encompassing all levels of prevention, particularly that for secondary prevention as the chief domain of investment. The EUROASPIRE study has reiterated the same in its conclusions and has emphasized secondary prevention incentives hold promise for better cardiovascular outcomes.
Therefore, cardiac rehabilitation and secondary prevention measures when integrated with the primary health-care system (health promotion and education in tandem) of a nation's health organization hold tremendous potential toward global cardiovascular health.
Notwithstanding that the aforesaid strategic proposals are of paramount importance in their own right, it would be lacking of substance to conclude without emphasizing upon the “unmet” need of healthier cardiac friendly lifestyle changes in CVD/“at risk” cases to complement, if not supplement pharmacological therapy as the first step toward “healthier hearts” in times to come.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Pyörälä K, De Backer G, Graham I, Poole-Wilson P, Wood D. Prevention of coronary heart disease in clinical practice. Recommendations of the task force of the European society of cardiology, European atherosclerosis society and European society of hypertension. Eur Heart J 1994;15:1300-31.
De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al.
European guidelines on cardiovascular disease prevention in clinical practice: Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2003;10:S1-10.
EUROASPIRE. A European society of cardiology survey of secondary prevention of coronary heart disease: Principal results. EUROASPIRE study group. European action on secondary prevention through intervention to reduce events. Eur Heart J 1997;18:1569-82.
Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U, et al.
EUROASPIRE III: A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009;16:121-37.
EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro heart survey programme. Eur Heart J 2001;22:554-72.
[Table 1], [Table 2]