Many patients with CHD continue smoking after MI

More than half of patients with heart disease who are smokers continue to do so after hospitalization for an acute coronary event or coronary revascularization, according to a presentation from EuroPrevent.

Additionally, according to results of the EUROASPIRE V survey, nearly half of patients with obesity have no plans for weight loss.

“You may take the view that these are altogether two depressing results,” David A. Wood, MD, from Imperial College London, said during his presentation. “Or you could take the view as I do, that there is huge potential here for improvement based on evidence from randomized controlled trials, and I want to remind you about the evidence base on which we practice in the context of cardiac rehab and secondary prevention.”

According to the presentation, EUROASPIRE examined CV risk factors in 8,261 patients with established CHD from 27 countries who were interviewed and clinically examined 6 months to 2 years after hospitalization for an acute coronary event or coronary revascularization.

The results of the survey showed that 55% of the patients who were smokers before hospitalization were still smoking a year after MI incidence.

Additionally, the survey showed that 38% of patients were obese, and of those who were obese, 45% had no plans for weight loss, and 25% had never been told they had a weight problem.

It was found that 59% of those who took the survey were centrally obese (waist circumference 88 cm in women and 102 cm in men).

Among patients who took the survey, prevalence of hypertension was 46%, whereas 12% of patients had systolic BP of at least 160 mm Hg or diastolic BP of at least 100 mm Hg. Antihypertensive drugs were used in 78% of patients (range, 49-83), of whom 49% had controlled BP.

The researchers observed a prevalence of elevated LDL of 71%. In the cohort, 84% of patients were assigned lipid-lowering therapy, almost exclusively statins. Of the patients receiving statins, only 32% reached an LDL target of less than 1.8 mmol/L (70 mg/dL). According to Wood, 93% were on antiplatelet medication, 81% were on beta-blockers and 75% were on ACE inhibitors or angiotensin receptor blockers.

Although 29% of patients reported that they had diabetes, only 54% of these patients had HbA1c less than 7%. An oral glucose tolerance test revealed that 12% of patients with diabetes had newly detected diabetes, 18% had impaired glucose tolerance and 10% had impaired fasting glycemia.

Cardiac rehabilitation programs were suggested to 46% of patients, and only 32% attended at least half of the sessions.

“In offering a preventive cardiology program to achieve the enormous potential for risk factor reduction in patients with atherosclerotic disease, it needs to be multidisciplinary, comprehensive, addressing lifestyle and other risk factors and using evidence-based medications. Actually, such a program [that] addresses lifestyle and risk factors and uses evidence-based medications is equally important for primary prevention as well,” Wood concluded in his presentation. “Such a program addresses the complete continuum of cardiovascular risk. We as a prevention and rehab community or as a preventive cardiology community should be addressing both secondary and primary prevention with the wealth of expertise that we have at our hands.” – by Dave Quaile

Reference:

Wood DA, et al. What is new in the management of people with CHD? EUROASPIRE V survey on cardiovascular disease prevention and diabetes. Presented at: EuroPrevent; April 19-21, 2018; Ljubljana, Slovenia.

Disclosure: Wood reports no relevant financial disclosures.