BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54% and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0% (53 mmol/mol) in 95 and 53% and 11% of those with previously known diabetes had an HbA1c >9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.

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 Karolinska Institutet Karolinska University Hospital Solna 171 76 Stockholm Sweden

Center for Cardiovascular Prevention 1st School of Medicine Charles University and Thomayer Hospital Vídeňská 800 140 59 Prague Czech Republic

Centre for Family Medicine Department of Neurobiology Care Sciences and Society Karolinska Institutet Huddinge Sweden

Centre for Medical Research School of Medicine University of Banja Luka Vuka Karadzica 6 78000 Banja Luka Republic of Srpska Bosnia and Herzegovina

Centre for Vascular Prevention Danube University Krems Krems Austria

Clinic for Internal Medicine Intermedica Jovana Ristica 20 2 18000 Nis Serbia

Clinic of Cardiovascular Diseases of Vilnius University Santariskiu 2 08661 Vilnius Lithuania

Clinical Center University of Sarajevo Bolnička 25 71000 Sarajevo Bosnia and Herzegovina

Clinical Trial Center Würzburg University Hospital Würzburg Josef Schneider Str 2 97080 Würzburg Germany

Comprehensive Heart Failure Center University of Würzburg Würzburg Germany

Comprehensive Heart Failure Centre and Department of Medicine 1 University of Würzburg Straubmühlweg 2a 97078 Würzburg Germany

Department of Cardiology National Heart Hospital 65 Konyovitsa 1309 Sofia Bulgaria

Department of Cardiology of Shupyk's Medical Academy of Postgraduate Education 9 Dorohozhyts'ka str Kiev 04112 Ukraine

Department of Cardiovascular Medicine National Heart and Lung Institute Imperial College London London UK

Department of Chronic Disease Prevention National Institute for Health and Welfare Helsinki Finland

Department of Epidemiology and Population Studies Faculty of Health Sciences Jafiellonian University Medical College Grzegórzecka 20 31 531 Cracow Poland

Department of Heart failure and Valve Disease Skåne University Hospital Lund Sweden

Department of Internal Medicine University of Ghent De Pintelaan 185 9000 Ghent Belgium

Department of Public Health Ghent University Ghent Belgium

Diabetes Research Group King Abdulaziz University Jeddah Saudi Arabia

European Society of Cardiology Les Templiers 2035 route des Colles CS 80179 BIOT 06903 Sophia Antipolis Cedex France

Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention National Research Centre for Preventive Medicine 10 Petroverigsky per 101953 Moscow Russia

Forschergruppe Diabetes e 5 at the Helmholtz Center Munich Germany

Hacettepe University 06690 Ankara Turkey

Heart and Vascular Medicine of Vilnius University Hospital Santariskiu Clinics Santariskiu 2 08661 Vilnius Lithuania

Institut Pasteur de Lille Inserm U744 Université Lille Nord de France 1 rue du Professeur Calmette B P 245 59019 Lille France

Institute of Clinical Epidemiology and Biometry University of Würzburg Würzburg Germany

Instituto de Investigacion Sanitaria del Hospital Universario LaPaz Madrid Spain

Institutul de Boli Cardiovasculare Universitatea de Medicina si Farmacie Victor Babes Timisoara Romania

Kuopio University Hospital Rakennus 5 6 Kerros Puijonlaaksontie 2 70210 Kuopio Finland

Medical Faculty University of Ljubljana Vrazov trg 2 1000 Ljubljana Slovenia

National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation 10 Petroverigsky per 101990 Moscow Russia

Preventive Cardiology Unit Division of Internal Medicine University Medical Centre Ljubljana Zaloška 7 1525 Ljubljana Slovenia

The Adelaide and Meath Hospital Tallaght Dublin 24 Ireland

Thoraxcenter's Department of Cardiology Dr Molewaterplein 50 3000 DR Rotterdam The Netherlands

University Hospital Centre Zagreb School of Medicine University of Zagreb Kišpatićeva 12 10000 Zagreb Croatia

University of Latvia Pauls Stradins Clinical University Hospital Pilsonu Street 13 Riga 1002 Latvia

University of Nicosia Medical School Nicosia General Hospital 2029 Strovolos Nicosia Cyprus

University of Zagreb School of Medicine and University Hospital Centre Zagreb Kispaticeva 12 HR 10000 Zagreb Croatia

Zobrazit více v PubMed

Norhammar A, Tenerz Å, Nilsson G, Hamsten A, Efendic S, Rydén L, Malmberg K. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359(9324):2140–2144. doi: 10.1016/S0140-6736(02)09089-X. PubMed DOI

Tierney EF, Geiss LS, Engelgau MM, Thompson DJ, Schaubert D, Shireley LA, et al. Population-based estimates of mortality associated with diabetes: use of a death certificate check box in North Dakota. Am J Publ Health. 2001;91(1):84–92. doi: 10.2105/AJPH.91.1.84. PubMed DOI PMC

International Diabetes Federation. IDF Diabetes Atlas teB, Belgium: International Diabetes Federation; 2011. http://www.idf.org/diabetesatlas. Accessed 3 Dec 2014.

Norhammar A, Lindbäck J, Rydén L, Wallentin L, Stenestrand U. Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission. Heart. 2007;93(12):1577–1583. doi: 10.1136/hrt.2006.097956. PubMed DOI PMC

De Bacquer D, De Backer G, Ostor E, Simon J, Pyörälä K. Predictive value of classical risk factors and their control in coronary patients: a follow-up of the EUROASPIRE I cohort. Eur J Cardiovasc Prev Rehab. 2003;10(4):289–295. doi: 10.1097/00149831-200308000-00012. PubMed DOI

Anselmino M, Malmberg K, Öhrvik J, Rydén L. Evidence-based medication and revascularization: powerful tools in the management of patients with diabetes and coronary artery disease: a report from the Euro Heart Survey on diabetes and the heart. Eur J Cardiovasc Prev Rehab. 2008;15(2):216–223. doi: 10.1097/HJR.0b013e3282f335d0. PubMed DOI

Anselmino M, Bartnik M, Malmberg K, Rydén L. Management of coronary artery disease in patients with and without diabetes mellitus. Acute management reasonable but secondary prevention unacceptably poor: a report from the Euro Heart Survey on Diabetes and the Heart. Eur J Cardiovasc Prev Rehab. 2007;14(1):28–36. doi: 10.1097/01.hjr.0000199496.23838.83. PubMed DOI

Gyberg V, Kotseva K, Dallongeville J, Backer GD, Mellbin L, Rydén L, et al. Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III cross-sectional study. Eur J Prev Cardiol. 2014;e-publ. doi:10.1177/2047487314529353. PubMed

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren VM, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Atherosclerosis. 2012;223(1):1–68. doi: 10.1016/j.atherosclerosis.2012.05.007. PubMed DOI

Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur Heart J. 2007;28(1):88–136. PubMed

Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD) Eur Heart J. 2013;34(39):3035–3087. doi: 10.1093/eurheartj/eht108. PubMed DOI

Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, et al. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from twenty-four European countries. Eur J Prev Cardiol. 2015. pii: 2047487315569401. [Epub ahead of print]. PubMed

Lean MEJ, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311(6998):158–161. doi: 10.1136/bmj.311.6998.158. PubMed DOI PMC

Middleton ET, Morice AH. Breath carbon monoxide as an indication of smoking habit. Chest. 2000;117(3):758–763. doi: 10.1378/chest.117.3.758. PubMed DOI

Hannestad U, Lundblad A. Accurate and precise isotope dilution mass spectrometry method for determining glucose in whole blood. Clin Chem. 1997;43(5):794–800. PubMed

Carstensen B, Lindström J, Sundvall J, Borch-Johnsen K, Tuomilehto J. Measurement of blood glucose: comparison between different types of specimens. Ann Clin Biochem. 2008;45(Pt 2):140–148. doi: 10.1258/acb.2007.006212. PubMed DOI

Brown H, Prescott R. Applied mixed models in medicine. 2. New York: Wiley; 2006.

Gyberg V, De Bacquer D, Kotseva K, De Backer G, Schnell O, Sundvall J, et al. Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test, and HbA1c: a report from EUROASPIRE IV-a survey from the European Society of Cardiology. Eur Heart J. 2015. doi:http://dx.doi.org/10.1093/eurheartj/ehv008. First published online: 10 Feb 2015. PubMed DOI

Barengo NC, Tuomilehto JO. Blood pressure treatment target in patients with diabetes mellitus—current evidence. Ann Med. 2012;44(Suppl 1):S36–S42. doi: 10.3109/07853890.2012.679961. PubMed DOI

Mancia G, Schumacher H, Redon J, et al. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) Circulation. 2011;124(16):1727–1736. doi: 10.1161/CIRCULATIONAHA.110.008870. PubMed DOI

Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. New Engl J Med. 2008;358(6):580–591. doi: 10.1056/NEJMoa0706245. PubMed DOI

Gaede P, Pedersen O. Intensive integrated therapy of type 2 diabetes: implications for long-term prognosis. Diabetes. 2004;53(Suppl 3):S39–S47. doi: 10.2337/diabetes.53.suppl_3.S39. PubMed DOI

Sacks FM, Hermans MP, Fioretto P, Valensi P, Davis T, Horton E, et al. Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case–control study in 13 countries. Circulation. 2014;129(9):999–1008. doi: 10.1161/CIRCULATIONAHA.113.002529. PubMed DOI

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–13. PubMed PMC

Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. 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 Rehab. 2009;16(2):121–137. doi: 10.1097/HJR.0b013e3283294b1d. PubMed DOI

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53. PubMed

Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Card. 2009;53(3):296–304. doi: 10.1016/j.jacc.2008.10.008. PubMed DOI

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. New Engl J Med. 2008;359(15):1577–1589. doi: 10.1056/NEJMoa0806470. PubMed DOI

Sánchez RCC, Carcía J, Tuomilehto J, Rydén L. EuroHeart II project. Work Package 9. Second Programme of Community Action in the Field of Health (2008–2013). 2014.

Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet. 2008;371(9629):1999–2012. doi: 10.1016/S0140-6736(08)60868-5. PubMed DOI

Moe B, Augestad LB, Nilsen TIL. Diabetes severity and the role of leisure time physical exercise on cardiovascular mortality: the Nord-Trondelag Health Study (HUNT), Norway. Cardiovasc Diabetol. 2013;12:83–90. doi: 10.1186/1475-2840-12-83. PubMed DOI PMC

Ferrari R. EURObeservational Research Programme. Europ Heart J. 2010;31:1023–1031. doi: 10.1093/eurheartj/ehq083. DOI