Trends in cardiovascular risk factors among patients with coronary heart disease: results from the EUROASPIRE I, II, and III surveys in the Münster region

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys

BACKGROUND

Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany.

METHODS

The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V).

RESULTS

384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%).

CONCLUSION

Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany

Introduction

Patients with a history of myocardial infarction (MI) are at very high risk of subsequent cardiovascular events. This study evaluated the association of treatment intensity and adherence to lipid-lowering therapies (LLT) with major adverse cardiovascular events (MACE) among post-MI patients in Germany.

Methods

We carried out a retrospective cohort study using German health claims data (2010–2015). We included patients ≥ 18 years, with a history of MI and who started an LLT (statin and/or ezetimibe), between 2011 and 2013. The follow-up period started 1 year after the second LLT prescription and continued until MACE, all-cause death or December 31, 2015, whichever occurred first. Treatment intensity was classified based on expected low-density lipoprotein cholesterol reduction; adherence was measured by the proportion of days covered using prescription data. A combined adherence-adjusted intensity variable was created by multiplying intensity and adherence. We used Cox proportional hazards models to control for age, sex, Charlson Comorbidity Index and other cardiovascular risk factors at baseline.

Results

A total of 14,944 patients were included. Mean age was 66.7 (SD = 13.0) years; 68.7% of patients were men. Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was associated with a decrease in the risk of MACE of 17% (HR = 0.83, 95% CI 0.79–0.87), 5% (HR = 0.95, 95% CI 0.94–0.97), and 14% (HR = 0.86, 95% CI 0.83–0.90), respectively.

Conclusions

Higher treatment intensity and/or adherence of LLT was associated with significantly lower risk of MACE in post-MI patients. Strategies to tailor intensity to patient profiles and improve adherence could reduce the risk of cardiovascular events.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01697-8.

Do acute coronary events affect lipid management and cholesterol goal attainment in Germany? : Results from the Dyslipidemia International study II

Objective

To document utilization of lipid-lowering therapy, attainment of low-density lipoprotein cholesterol target values, and cardiovascular outcomes in patients hospitalized for acute coronary syndrome in Germany.

Methods

The Dyslipidemia International Study II was a multicenter, observational study of the prevalence of dyslipidemia and lipid target value attainment in patients surviving any acute coronary syndrome event. Among patients on lipid-lowering therapy for ≥3 months, use of lipid-lowering therapy and lipid profiles were assessed at admission and again at 120 ± 15 days after admission (the follow-up time point). Multivariate logistic regression was used to identify variables predictive of low-density lipoprotein cholesterol target value attainment in patients using lipid-lowering therapy.

Results

A total of 461 patients hospitalized for acute coronary syndrome were identified, 270 (58.6%) of whom were on lipid-lowering therapy at admission. Among patients on lipid-lowering therapy, 90.7% and 85.9% were receiving statin monotherapy at admission and follow-up, respectively. Mean (SD) low-density lipoprotein cholesterol levels in patients on lipid-lowering therapy were 101 (40) mg/dl and 95 (30) mg/dl at admission and follow-up, respectively. In patients with data at both admission and follow-up (n = 61), low-density lipoprotein cholesterol target value attainment rates were the same (19.7%) at both time points. Smoking was associated with a 77% lower likelihood of attaining the low-density lipoprotein cholesterol target value.

Conclusion

Hospitalization for an acute event does not greatly alter lipid management in acute coronary syndrome patients in Germany. Both lipid-lowering therapy doses and rates of low-density lipoprotein cholesterol target value attainment remained essentially the same several months after the event.

Physical activity levels of patients prior to acute coronary syndrome - Experience at a tertiary care hospital in Sri Lanka

OBJECTIVES

Physical inactivity is associated with high cardiovascular risk. The purpose of this study was to study physical activity levels of patients with acute coronary syndrome (ACS).

METHODOLOGY

A total of 504 patients, from the Professorial Unit of the Colombo South Teaching Hospital completed the International Physical Activity Questionnaire (IPAQ). IPAQ is a validated questionnaire used internationally to objectively measure physical activity. Both the total volume and the number of sessions of activity are included in the IPAQ. Populations are divided into three levels based on physical activity levels: low, moderate and high activity.

RESULTS

Out of 504 patients, 128 (25.1%) were highly active, 87 (17.1%) were minimally active and 289 (56.7%) were found be inactive. When considering mets per week 134 (26.3%) spent less than 1000mets/week. Physical activity levels of men and women were similar (p=0.06). There was a no significant association between body mass index (BMI) with total IPAQ score (p=0.11). There was no difference in the physical activity levels of patients presenting with different types of ACS: ST-Elevation Myocardial Infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA) (p=0.36). The activity levels did not affect the severity of ACS assessed by Thrombolysis In Myocardial Infarction (TIMI) scores. (NSTEMI/UA p=0.24, STEMI p=0.10).

CONCLUSION

In Sri Lanka, a majority of patients with ACS were physically inactive. Physical inactivity is one of the remediable major risk factors of ACS and an active life style should be promoted.

Time trends in incidence of pathological and etiological stroke subtypes during 16 years: the Erlangen Stroke Project

BACKGROUND

Population-based data, which continuously monitors time trends in stroke epidemiology are limited. We investigated the incidence of pathological and etiological stroke subtypes over a 16 year time period.

METHODS

Data were collected within the Erlangen Stroke Project (ESPro), a prospective, population-based stroke register in Germany covering a total study population of 105,164 inhabitants (2010). Etiology of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.

RESULTS

Between January 1995 and December 2010, 3,243 patients with first-ever stroke were documented. The median age was 75 and 55% were females. The total stroke incidence decreased over the 16 year study period in men (Incidence Rate Ratio 1995-1996 vs. 2009-2010 (IRR) 0.78; 95% CI 0.58-0.90) but not in women. Among stroke subtypes, a decrease in ischemic stroke incidence (IRR 0.73; 95% CI 0.57-0.93) and of large artery atherosclerotic stroke (IRR 0.27; 95% CI 0.12-0.59) was found in men and an increase of stroke due to small artery occlusion in women (IRR 2.33; 95% CI 1.39-3.90).

CONCLUSIONS

Variations in time trends of pathological and etiological stroke subtypes were found between men and women that might be linked to gender differences in the development of major vascular risk factors in the study population.

[Prevalence of arterial hypertension in the population of Western Germany: Heinz Nixdorf Recall Study]

Regional disparities in the prevalence of arterial hypertension in Germany have been reported in population-based surveys. An analysis comparing the SHIP study in the north-eastern region of Germany (1997-2001) with the MONICA/KORA-S4 study (1999-2001) in the south-west of Germany showed a significantly higher age-adjusted prevalence in the north-eastern population. The Heinz Nixdorf Recall Study is a population based prospective cohort study designed to assess cross-sectional and longitudinal data of risk factors, subclinical signs of atherosclerosis and cardiovascular endpoints in the Ruhr area of Germany. A total of 4,443 subjects without coronary artery disease aged 45-75 years could be included between 2000 und 2003 and the prevalence of hypertension, defined by JNC-7, was 63% in men and 52% in women. Low rates of hypertension awareness, treatment and control rates in population-based surveys as well as in recently published high risk cohorts with known coronary artery disease in Germany elucidate the need to optimize the strategies of screening, treatment and follow-up in primary and secondary prevention. Coronary artery calcification was demonstrated to be an independent risk factor for cardiovascular endpoints even in the stage of prehypertension. The risk-benefit ratio for an early treatment of these patients could be improved by advanced risk stratification, assessing the level of coronary artery calcification.