Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

Cardiovascular Diabetology

Dusko Vulic⁴  Lale Tokgözoğlu¹  Stefan Störk^1,12  Martin Stagmo^2,21  Zeljko Reiner³  Nana Pogosova^1,17  Andrzej Pająk^1,13  Raphael Oganov^2,22  Evagoras Nicolaides^1,16  David Moore²  Davor Miličić^1,18  Dragan Lovic^1,11  Seppo Lehto⁷  Aleksandras Laucevicius^1,19  Peter Heuschmann^1,15  John Goudevenos^1,19  Nina Gotcheva⁵  Dan Gaita^1,19  Zlatko Fras^1,19  Andrejs Erglis^1,19  Maryna Dolzhenko^2,24  Mirza Dilic^1,19  Johan De Sutter^1,19  Jaap W. Deckers^1,19  Renata Cifkova^1,19  Almudena Castro Conde^2,20  Jan Bruthans^1,19  Philippe Amouyel^2,23  Lars Rydén^1,19  David Wood⁹  Jaakko Tuomilehto⁸  Oliver Schnell⁶  Linda Mellbin^1,19  Kornelia Kotseva⁹  Catriona Jennings⁹  Guy De Backer^1,10  Dirk De Bacquer^1,10  Viveca Gyberg^1,14 

[1] Hacettepe University, Ankara, 06690, Turkey;The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland;University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kišpatićeva 12, Zagreb, 10000, Croatia;Centre for Medical Research, School of Medicine, University of Banja Luka, Vuka Karadzica 6, Banja Luka, 78000, Republic of Srpska, Bosnia and Herzegovina;Department of Cardiology, National Heart Hospital, 65, Konyovitsa, Sofia, 1309, Bulgaria;Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany;Kuopio University Hospital, Rakennus 5/6. Kerros, Puijonlaaksontie 2, Kuopio, 70210, Finland;Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain;Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK;Department of Public Health, Ghent University, Ghent, Belgium;Clinic for Internal Medicine Intermedica, Jovana Ristica 20/2, Nis, 18000, Serbia;Comprehensive Heart Failure Centre and Department of Medicine I, University of Würzburg, Straubmühlweg 2a, Würzburg, 97078, Germany;Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jafiellonian University Medical College, Grzegórzecka 20, Cracow, 31-531, Poland;Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden;Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany;University of Nicosia Medical School, Nicosia General Hospital, 2029 Strovolos, Nicosia, Cyprus;Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention, National Research Centre for Preventive Medicine, 10 Petroverigsky per, Moscow, 101953, Russia;University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, HR-10000, Croatia;European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, Sophia Antipolis Cedex, 06903, France;Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain;Department of Heart failure and Valve Disease, Skåne University Hospital, Lund, Sweden;National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, 10 Petroverigsky per, Moscow, 101990, Russia;Institut Pasteur de Lille, Inserm U744, Université Lille Nord de France, 1 rue du Professeur Calmette B.P. 245, Lille, 59019, France;Department of Cardiology of Shupyk’s Medical Academy of Postgraduate Education, 9 Dorohozhyts’ka str, Kiev 04112, Ukraine

关键词: Glycaemic control;    Blood pressure;    Blood lipids;    Guideline adherence;    Management;    Secondary prevention;    Type 2 diabetes;    Coronary artery disease;   

Others  :  1228712
DOI  :  10.1186/s12933-015-0296-y

 received in 2015-07-29, accepted in 2015-09-24,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Gyberg et al.

【 图 表 】

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