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

Centre for Cardiovascular Prevention 1st Medical Faculty Charles University and Thomayer Hospital Prague Czech Republic

Centre for Medical Research School of Medicine University of Banja Luka Banja Luka Bosnia and Herzegovina

Clinic for Internal Medicine Intermedica Nis Serbia

Clinic of Cardiovascular Diseases Vilnius University Vilnius Lithuania

Clinical Centre University of Sarajevo Sarajevo Bosnia and Herzegovina

Clinical Trial Centre Würzburg University Hospital Würzburg Würzburg Germany

Comprehensive Heart Failure Centre and Department of Medicine 1 University of Würzburg Würzburg Germany

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 Epidemiology and Population Studies Faculty of Health Sciences Jagiellonian University Medical College Kracow Poland

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

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

Hacettepe University Ankara Turkey

Heart and Vascular Medicine Vilnius University Hospital Santariskiu Clinics Vilnius Lithuania

Institut Pasteur de Lille Université de Lille Lille France

Institute of Clinical Epidemiology and Biometry University of Würzburg Würzburg Germany

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

International Centre for Circulatory Health National Heart and Lung Institute Imperial College London London UK

Kuopio University Hospital Kuopio Finland

National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation Moscow Russia

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

University Medical Centre Ljubljana Slovenia

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