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Incidence of cardiovascular events in patients with stabilized coronary heart disease: the EUROASPIRE IV follow-up study
D. De Bacquer, D. De Smedt, K. Kotseva, C. Jennings, D. Wood, L. Rydén, V. Gyberg, B. Shahim, P. Amouyel, J. Bruthans, A. Castro Conde, R. Cífková, JW. Deckers, J. De Sutter, M. Dilic, M. Dolzhenko, A. Erglis, Z. Fras, D. Gaita, N. Gotcheva, J....
Language English Country Netherlands
Document type Journal Article
- MeSH
- Incidence MeSH
- Cardiovascular Diseases epidemiology MeSH
- Coronary Disease therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Cross-Sectional Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Life Style MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
The EUROASPIRE surveys (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) demonstrated that most European coronary patients fail to achieve lifestyle, risk factor and therapeutic targets. Here we report on the 2-year incidence of hard cardiovascular (CV) endpoints in the EUROASPIRE IV cohort. EUROASPIRE IV (2012-2013) was a large cross-sectional study undertaken at 78 centres from selected geographical areas in 24 European countries. Patients were interviewed and examined at least 6 months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1 year after this baseline screening were registered. The primary outcome in our analyses was the incidence of CV death or non-fatal myocardial infarction, stroke or heart failure. Cox regression models, stratified for country, were fitted to relate baseline characteristics to outcome. Our analyses included 7471 predominantly male patients. Overall, 222 deaths were registered of whom 58% were cardiovascular. The incidence of the primary outcome was 42 per 1000 person-years. Comorbidities were strongly and significantly associated with the primary outcome (multivariately adjusted hazard ratio HR, 95% confidence interval): severe chronic kidney disease (HR 2.36, 1.44-3.85), uncontrolled diabetes (HR 1.89, 1.50-2.38), resting heart rate ≥ 75 bpm (HR 1.74, 1.30-2.32), history of stroke (HR 1.70, 1.27-2.29), peripheral artery disease (HR 1.48, 1.09-2.01), history of heart failure (HR 1.47, 1.08-2.01) and history of acute myocardial infarction (HR 1.27, 1.05-1.53). Low education and feelings of depression were significantly associated with increased risk. Lifestyle factors such as persistent smoking, insufficient physical activity and central obesity were not significantly related to adverse outcome. Blood pressure and LDL-C levels appeared to be unrelated to cardiovascular events irrespective of treatment. In patients with stabilized CHD, comorbid conditions that may reflect the ubiquitous nature of atherosclerosis, dominate lifestyle-related and other modifiable risk factors in terms of prognosis, at least over a 2-year follow-up period.
Cardiac Rehabilitation Unit Cardiology Department Hospital Universitario La Paz Madrid Spain
Cardiology Department of Medical School University of Ioannina Ioannina Greece
Cardiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
Clinic for Internal Medicine Intermedica Nis Serbia
Clinical Centre University of Sarajevo Sarajevo Bosnia and Herzegovina
Department of Cardiology National Heart Hospital Sofia Bulgaria
Department of Cardiology Shupyk's National Medical Academy of Postgraduate Education Kiev Ukraine
Department of Cardiology Thoraxcentre Rotterdam The Netherlands
Department of Heart Failure and Valve Disease Skåne University Hospital Lund Sweden
Department of Internal Medicine Ghent University Ghent Belgium
Department of Public Health Ghent University De Pintelaan 185 4K3 9000 Ghent Belgium
Hacettepe University Ankara Turkey
Institut Pasteur de Lille Université de Lille Lille France
Kuopio University Hospital Kuopio Finland
Nicosia General Hospital University of Nicosia Medical School Nicosia Cyprus
Pauls Stradins Clinical University Hospital University of Latvia Riga Latvia
The Adelaide and Meath Hospital Dublin Ireland
University Hospital Centre Zagreb School of Medicine University of Zagreb Zagreb Croatia
References provided by Crossref.org
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- $a The EUROASPIRE surveys (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) demonstrated that most European coronary patients fail to achieve lifestyle, risk factor and therapeutic targets. Here we report on the 2-year incidence of hard cardiovascular (CV) endpoints in the EUROASPIRE IV cohort. EUROASPIRE IV (2012-2013) was a large cross-sectional study undertaken at 78 centres from selected geographical areas in 24 European countries. Patients were interviewed and examined at least 6 months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1 year after this baseline screening were registered. The primary outcome in our analyses was the incidence of CV death or non-fatal myocardial infarction, stroke or heart failure. Cox regression models, stratified for country, were fitted to relate baseline characteristics to outcome. Our analyses included 7471 predominantly male patients. Overall, 222 deaths were registered of whom 58% were cardiovascular. The incidence of the primary outcome was 42 per 1000 person-years. Comorbidities were strongly and significantly associated with the primary outcome (multivariately adjusted hazard ratio HR, 95% confidence interval): severe chronic kidney disease (HR 2.36, 1.44-3.85), uncontrolled diabetes (HR 1.89, 1.50-2.38), resting heart rate ≥ 75 bpm (HR 1.74, 1.30-2.32), history of stroke (HR 1.70, 1.27-2.29), peripheral artery disease (HR 1.48, 1.09-2.01), history of heart failure (HR 1.47, 1.08-2.01) and history of acute myocardial infarction (HR 1.27, 1.05-1.53). Low education and feelings of depression were significantly associated with increased risk. Lifestyle factors such as persistent smoking, insufficient physical activity and central obesity were not significantly related to adverse outcome. Blood pressure and LDL-C levels appeared to be unrelated to cardiovascular events irrespective of treatment. In patients with stabilized CHD, comorbid conditions that may reflect the ubiquitous nature of atherosclerosis, dominate lifestyle-related and other modifiable risk factors in terms of prognosis, at least over a 2-year follow-up period.
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