Most Patients Don't Meet CV Primary Prevention Treatment Targets: EUROASPIRE V

Marlene Busko

December 20, 2018

DUBAI, United Arab Emirates — Fewer than half of patients receiving therapy for hypertension, dyslipidemia, or diabetes in primary care practices, mainly in Europe, meet guideline treatment targets for primary prevention of cardiovascular disease (CVD), suggests a new analysis from the EUROASPIRE V survey.

"It is disappointing," Kornelia Kotseva, MD, PhD, told theheart.org | Medscape Cardiology in an email, that "fewer than half of patients on antihypertensive and lipid-lowering medications had blood pressure and LDL cholesterol controlled, and fewer than two thirds of patients with diabetes reached their HbA1C targets."

It's concerning, she said, "that there was no improvement of lifestyle management with high prevalence of obesity and central obesity," with "only about a third of high-CVD-risk patients reaching their targets" for physical activity.

Kotseva, of the National Heart and Lung Institute, Imperial College London, United Kingdom, is EUROASPIRE V steering committee chair. She presented the findings here at the World Congress of Cardiology & Cardiovascular Health. They are similar to results from the previous EUROASPIRE IV survey.

Kotseva urged primary care providers to be more proactive. General practitioners "need to go beyond treating the risk factors they know about," she said in a press release on the analysis issued by the European Society of Cardiology (ESC). They should "always investigate smoking, obesity, unhealthy diet, physical inactivity, blood pressure, cholesterol, and diabetes. In our study, many participants with high blood pressure and cholesterol were not being treated."

Data that indicate so few people are meeting primary prevention targets "are always shocking when you first look at them, though whenever investigators look, similar patterns of undertreatment of risk factors are seen," Deepak L. Bhatt, MD, MPH, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, said to theheart.org | Medscape Cardiology in an email.

"This is true globally, including in the USA," said Bhatt, who was not present for Kotseva's presentation of EUROASPIRE V. "The solution starts with lifestyle recommendations on a population level, with medical therapy, often generic, targeting higher-risk primary-prevention patients," he said.

"These results suggest that the cardiovascular epidemic is not going away any time soon," he continued. "We have to do better in terms of control of cardiovascular risk factors, so-called primary prevention."

More than that, he said, "We need to step back and try to do better in primordial prevention — that is, preventing the development of risk factors in the first place."

The primary prevention arm of EUROASPIRE V aimed to determine whether lifestyle and risk-marker targets for people at high risk of developing CVD — as recommended by the Sixth Joint European Societies guideline on CVD prevention, published in 2016 — were being met in everyday clinical practice.

The survey included 2759 adult patients younger than 80 years (mean age, 59 years; 58% women) who had been prescribed medication to treat hypertension, dyslipidemia, or diabetes within the past 6 months to 2 years. They were seen at 78 primary care centers in Bosnia and Herzegovina, Bulgaria, Croatia, the Czech Republic, Egypt, Greece, Kazakhstan, Kyrgyzstan, Lithuania, Poland, Portugal, Romania, Russia, Sweden, Ukraine, and the United Kingdom during 2017 and 2018.

About 37% were overweight, with a body mass index (BMI) 25 to 29.9 kg/m2; 44% were obese (BMI >30 kg/m2); and 64% had central obesity (waist circumference ≥88 cm for women, ≥102 cm for men).

About 18% smoked, and 36% reported that they were regularly physically active for at least 30 minutes five times a week.

Among those who were receiving antihypertensive drug therapy, 47% achieved the recommended blood pressure target of <140/90 mmHg or, for those with diabetes, <140/85 mmHg.

Most patients taking antihypertensives were receiving one or two agents (42% and 34%, respectively); 18% were receiving three agents; and 6% were taking at least four agents.

Similarly, among patients who had been prescribed a lipid-lowering agent, only 43% attained the recommended LDL-cholesterol target of <2.5 mmol/L. Such therapy consisted of statins in 97% of patients and fibrates in 3%; none were taking proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.

The overall poor control of blood pressure and lipid levels was likely due to multiple factors, including low-dose prescriptions, inadequate up-titration, poor patient adherence, and therapeutic inertia — that is, failure of physicians to initiate or intensify therapy when therapeutic targets were not reached, Kotseva said.

Among the 36% of patients with self-reported type 2 diabetes, 57% were being treated with diet drugs. An overlapping 79% were being treated with oral antidiabetic drugs, and 14% were receiving insulin. Only 65% attained the recommended HBA1C level of <7%.

"More efforts must be taken to improve cardiovascular prevention in apparently healthy people at high CVD risk," Kotseva concluded.

EUROASPIRE V was conducted under the auspices of the ESC EURObservational Research Programme. The survey was supported through research grants to the ESC from Amgen, Elli Lilly, Ferrer, NovoNordisk, Pfizer, and Sanofi. Dr Kotseva has received funding from the ESC.

World Congress of Cardiology & Cardiovascular Health: December 7, 2018.

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