European action on secondary and primary prevention of coronary heart disease in order to reduce events (part III)

The major European Scientific Societies in the field of cardiovascular medicine
(European Society of Cardiology (ESC), European Atherosclerosis Society (EAS)
and the European Society of Hypertension (ESH)) published recommendations on
prevention of CHD in clinical practice in 1994[1]. The aim of the Joint
European Societies recommendations on coronary prevention was to improve the
practice of preventive cardiology by encouraging the development of national
guidance on coronary prevention and its communication, implementation and
evaluation through national societies in each country.

In 1995-96 a European survey (EUROASPIRE I) was undertaken by the ESC in 21
centres from nine European countries. In 1998 a Second Joint European Societies
Task Force on coronary prevention was convened by the same three societies. The
recommendations of this Task Force reinforced the priorities and goals with
regard to lifestyle, risk factor and therapeutic management, given in the 1994
recommendations. Following the 1998 European Recommendations on Prevention of
CHD in clinical practise, a second EUROASPIRE survey (EUROASPIRE II) was
conducted in 1999/2000 in 47 centres (including 20 of the centres from the
first survey) in fifteen European countries.

The same methodology used in EUROASPIRE I was employed in the second survey
including standardized measurements, a central laboratory for lipid and glucose
analyses so that time trends between the first and second surveys could be
described. The objectives of this study were to determine first, whether
clinical practice was changing to achieve the full potential benefits of
coronary heart disease prevention.

However, EUROASPIRE I and II surveys both showed a high prevalence of unhealthy
lifestyles, modifiable risk factors and inadequate use of drug therapies to
achieve blood pressure and lipid goals in patients with established CHD, with
wide variations in medical practice between countries. The comparison of
EUROASPIRE I and II surveys showed adverse lifestyle trends, especially the
substantial increase in obesity in every country, and smoking among younger
patients.

So there is considerable potential throughout Europe in coronary patients and
their families to raise the standard of preventive cardiology through more
lifestyle intervention, control of other risk factors and optimal use of
prophylactic drug therapies in order to reduce risk of recurrent disease and
death.

The Joint European Recommendations have been recently revised by the Third
Joint Task Force, in which the original collaborating scientific societies were
joined by the European Association for the Study of Diabetes and by the
International Diabetes Federation Europe.

The Third Joint European Societies recommendations on CVD prevention define the
following priorities for CVD prevention in clinical practice:
1. patients with established coronary heart disease, peripheral artery disease
and cerebrovascular atherosclerotic disease
2. asymptomatic individuals who are at high risk of developing atherosclerotic
cardiovascular diseases

A third EUROASPIRE survey will be based on hospital patients with coronary
heart disease, their blood relatives (if there is premature CHD) and apparently
healthy individuals in primary care at high risk of developing cardiovascular
disease. A survey is proposed in 2006/2007.

Retrospective survey of patients consecutively identified following discharge
for coronary event, or being treated for hypertension, hypercholesterolemia or
diabetes.

Risks not applicable. Direct benefit for participants is possible through
renewed measurement (and subsequent modification / better treatment) of the
major risk factors for new CV complications.