TY - JOUR A1 - Ungethüm, K. A1 - Wiedmann, S. A1 - Wagner, M. A1 - Leyh, R. A1 - Ertl, G. A1 - Frantz, S. A1 - Geisler, T. A1 - Karmann, W. A1 - Prondzinsky, R. A1 - Herdeg, C. A1 - Noutsias, M. A1 - Ludwig, T. A1 - Käs, J. A1 - Klocke, B. A1 - Krapp, J. A1 - Wood, D. A1 - Kotseva, K. A1 - Störk, S. A1 - Heuschmann, P. U. T1 - 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 JF - Clinical Research in Cardiology N2 - 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. KW - coronary heart disease KW - diabetes mellitus KW - secondary prevention KW - EUROASPIRE Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324037 VL - 112 IS - 2 ER - TY - JOUR A1 - Schwaab, Bernhard A1 - Bjarnason-Wehrens, Birna A1 - Meng, Karin A1 - Albus, Christian A1 - Salzwedel, Annett A1 - Schmid, Jean-Paul A1 - Benzer, Werner A1 - Metz, Matthes A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Bönner, Gerd A1 - Brzoska, Patrick A1 - Buhr-Schinner, Heike A1 - Charrier, Albrecht A1 - Cordes, Carsten A1 - Dörr, Gesine A1 - Eichler, Sarah A1 - Exner, Anne-Kathrin A1 - Fromm, Bernd A1 - Gielen, Stephan A1 - Glatz, Johannes A1 - Gohlke, Helmut A1 - Grilli, Maurizio A1 - Gysan, Detlef A1 - Härtel, Ursula A1 - Hahmann, Harry A1 - Herrmann-Lingen, Christoph A1 - Karger, Gabriele A1 - Karoff, Marthin A1 - Kiwus, Ulrich A1 - Knoglinger, Ernst A1 - Krusch, Christian-Wolfgang A1 - Langheim, Eike A1 - Mann, Johannes A1 - Max, Regina A1 - Metzendorf, Maria-Inti A1 - Nebel, Roland A1 - Niebauer, Josef A1 - Predel, Hans-Georg A1 - Preßler, Axel A1 - Razum, Oliver A1 - Reiss, Nils A1 - Saure, Daniel A1 - von Schacky, Clemens A1 - Schütt, Morten A1 - Schultz, Konrad A1 - Skoda, Eva-Maria A1 - Steube, Diethard A1 - Streibelt, Marco A1 - Stüttgen, Martin A1 - Stüttgen, Michaela A1 - Teufel, Martin A1 - Tschanz, Hansueli A1 - Völler, Heinz A1 - Vogel, Heiner A1 - Westphal, Ronja T1 - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2 JF - Journal of Clinical Medicine N2 - Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively. KW - cardiac rehabilitation KW - scientific guidelines KW - secondary prevention KW - physical activity KW - exercise training KW - psychological interventions KW - education KW - gender KW - frailty KW - migration KW - old patients KW - young patients KW - tele-medicine KW - home-based-rehabilitation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242645 SN - 2077-0383 VL - 10 IS - 14 ER - TY - JOUR A1 - Rauch, Bernhard A1 - Salzwedel, Annett A1 - Bjarnason-Wehrens, Birna A1 - Albus, Christian A1 - Meng, Karin A1 - Schmid, Jean-Paul A1 - Benzer, Werner A1 - Hackbusch, Matthes A1 - Jensen, Katrin A1 - Schwaab, Bernhard A1 - Altenberger, Johann A1 - Benjamin, Nicola A1 - Bestehorn, Kurt A1 - Bongarth, Christa A1 - Dörr, Gesine A1 - Eichler, Sarah A1 - Einwang, Hans-Peter A1 - Falk, Johannes A1 - Glatz, Johannes A1 - Gielen, Stephan A1 - Grilli, Maurizio A1 - Grünig, Ekkehard A1 - Guha, Manju A1 - Hermann, Matthias A1 - Hoberg, Eike A1 - Höfer, Stefan A1 - Kaemmerer, Harald A1 - Ladwig, Karl-Heinz A1 - Mayer-Berger, Wolfgang A1 - Metzendorf, Maria-Inti A1 - Nebel, Roland A1 - Neidenbach, Rhoia Clara A1 - Niebauer, Josef A1 - Nixdorff, Uwe A1 - Oberhoffer, Renate A1 - Reibis, Rona A1 - Reiss, Nils A1 - Saure, Daniel A1 - Schlitt, Axel A1 - Völler, Heinz A1 - Känel, Roland von A1 - Weinbrenner, Susanne A1 - Westphal, Ronja T1 - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — Part 1 JF - Journal of Clinical Medicine N2 - Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation. KW - cardiac rehabilitation standards KW - scientific guidelines KW - secondary prevention KW - coronary artery disease KW - chronic heart failure KW - heart valve repair KW - ICD-CRT KW - ventricular assist device KW - heart transplantation KW - peripheral artery disease KW - pulmonary hypertension KW - myocarditis KW - adults with congenital heart disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239709 SN - 2077-0383 VL - 10 IS - 10 ER - TY - JOUR A1 - Kotseva, Kornelia A1 - De Backer, Guy A1 - De Bacquer, Dirk A1 - Rydén, Lars A1 - Hoes, Arno A1 - Grobbee, Diederick A1 - Maggioni, Aldo A1 - Marques-Vidal, Pedro A1 - Jennings, Catriona A1 - Abreu, Ana A1 - Aguiar, Carlos A1 - Badariene, Jolita A1 - Bruthans, Jan A1 - Castro Conde, Almudena A1 - Cifkova, Renata A1 - Crowley, Jim A1 - Davletov, Kairat A1 - Deckers, Jaap A1 - De Smedt, Delphine A1 - De Sutter, Johan A1 - Dilic, Mirza A1 - Dolzhenko, Marina A1 - Dzerve, Vilnis A1 - Erglis, Andrejs A1 - Fras, Zlatko A1 - Gaita, Dan A1 - Gotcheva, Nina A1 - Heuschmann, Peter A1 - Hasan-Ali, Hosam A1 - Jankowski, Piotr A1 - Lalic, Nebojsa A1 - Lehto, Seppo A1 - Lovic, Dragan A1 - Mancas, Silvia A1 - Mellbin, Linda A1 - Milicic, Davor A1 - Mirrakhimov, Erkin A1 - Oganov, Rafael A1 - Pogosova, Nana A1 - Reiner, Zeljko A1 - Stöerk, Stefan A1 - Tokgözoğlu, Lâle A1 - Tsioufis, Costas A1 - Vulic, Dusko A1 - Wood, David T1 - Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry JF - European Journal of Preventive Cardiology N2 - Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events. KW - EUROASPIRE KW - lifestyle KW - cardiovascular risk factors KW - secondary prevention KW - guidelines Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-205526 SN - 2047-4873 SN - 2047-4881 N1 - This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. VL - 26 IS - 8 ER - TY - THES A1 - Wagner, Martin T1 - Chronic Kidney Disease as an Important Co-morbid Condition in Coronary Heart Disease Patients T1 - Chronische Nierenerkrankung als bedeutender Risikofaktor bei Patienten mit koronarer Herzkrankheit N2 - In patients with coronary heart disease (CHD) the control of the modifiable “traditional” cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, achieving/maintaining normal body weight and smoking cessation is of major importance to improve prognosis. Guideline recommendations for secondary CHD prevention include specific treatment targets for blood pressure, lipid levels, and markers of glucose metabolism for both younger and older patients. Chronic kidney disease (CKD) has been identified as a “non-traditional” risk factor for worse outcome in CHD patients, as it is associated with a markedly increased risk for subsequent CV events and mortality. The specific objectives of the current thesis-project are to investigate (a) the quality of care in a recent sample of German CHD patients and to investigate variation of risk factor control between younger and elder patients (≤70 versus >70 years), (b) to analyze the prevalence of CKD across Europe in stable CHD patients in the outpatient setting and during a hospital stay for CHD, (c) to investigate the level of awareness of CKD in German CHD patients and their treating physicians. Data from the European-wide EUROASPIRE IV study were used that include data on 7998 CHD patients in the ambulatory setting (study visit) and during a hospital stay for CHD (index). The German EUROASPIRE IV study center in Würzburg recruited 536 patients in 2012-2013. Risk factor control was compared against the current recommendations of the European Society of Cardiology. CKD was described by stages of glomerular filtration rate (eGFR) and albuminuria. German patients were asked in an additional kidney specific module whether they have ever been told by a physician about renal impairment. The fact that CKD or acute kidney injury (AKI) was mentioned in prominent parts of the hospital discharge letter as well as correct ICD-coding of CKD or AKI served as a proxy for physician’s awareness of CKD. The majority of German CHD patients was treated with the recommended drug therapies including e.g. β-blockers, anti-platelets and statins. However, treatment targets for blood pressure and LDL-cholesterol levels were not achieved in many patients (45% and 53%, respectively) and glycemic control in diabetic CHD patients with HbA1-levels <7% was insufficient (61%). A minority of patients reported on current smoking (10%), but unhealthy life-styles e.g. overweight/obesity (85%/37%) were frequent. Patterns of care differed between younger and older CHD patients while older patients were less likely to receive the recommended medical CHD-therapy, were more likely to have uncontrolled blood pressure and also to be diabetic. However, a greater proportion of diabetic patients >70 years was achieving the HbA1c target, and less elder patients were current smokers or were obese. About 17% of patients on average had CKD (eGFR< 60 ml/min/1.73m²) in the entire European sample at the study visit, and an additional 10% had albuminuria despite preserved eGFR, with considerable variation among countries. Impaired kidney function was observed in every fifth patient admitted for CHD in the entire European dataset of the EUROASPIRE IV study. Of the German CHD patients with CKD at the study visit, only a third were aware of their renal impairment. A minority of these patients was being seen by nephrologists, however, with a higher likelihood of CKD awareness and specialist care in more advanced stages of CKD. About a third of patients admitted for CHD showed either CKD or AKI during the hospital stay, but the discharge letter mentioned chronic or acute kidney disease only in every fifth of these patients. In contrast, correct ICD coding of CKD or AKI was more complete, but still suboptimal. In summary, quality of secondary prevention in German CHD patients indicates considerably room for improvement, with life-style modifications may become an even greater factor in prevention campaigns than medical treatment into certain target ranges. Preventive therapies should also consider different needs in older individuals acknowledging physical and mental potential, other comorbidities and drug-interactions with co-medication. CKD is common in CHD patients, not only in the elderly. Since CHD and CKD affect each other and impact on worse prognosis of each other, raising the awareness of CKD among patients and physicians and considering CKD in medical therapy may improve prognosis and slow disease progression of CHD as well as CKD. N2 - Bei Patienten mit koronarer Herzkrankheit (KHK) ist die Behandlung der „klassischen“ kardiovaskulären Risikofaktoren wie Bluthochdruck, Hypercholesterinämie, Diabetes, ein normales Körpergewicht sowie der Nikotinverzicht von Bedeutung, um die Prognose zu verbessern. Leitlinien empfehlen in der Sekundärprävention spezifische Behandlungsziele für Bluthochdruck, Hypercholesterinämie und Diabetes. Die chronische Niereninsuffizienz (NI) stellt einen „nicht-klassischen“ Risikofaktor für eine schlechtere Prognose bei KHK-Patienten dar und ist assoziiert mit einem erhöhten Risiko für eine Progression der KHK und kardiovaskuläre Mortalität. Die Studienziele der vorgelegten Arbeit beinhalten (a) die Umsetzung der KHK-Leitlinien in einem deutschen Kollektiv von Patienten inklusive der Unterschiede in der Versorgung zwischen Jüngeren und älteren Patienten (≤70 / >70 Jahre). Zudem (b) wird die Prävalenz der NI in stabilen ambulanten Verhältnissen und ebenso während eines Krankenhausaufenthaltes aufgrund eines KHK-Ereignisses in 24 Europäischen Ländern inklusive Deutschland untersucht. Schließlich (c) wird am deutschen Studienzentrum das Bewusstsein („Awareness“) für Nierenerkrankungen sowohl bei den Patienten als auch den behandelnden Ärzten analysiert. Es wurden die Daten der europaweiten EUROASPIRE IV Studie verwendet, für die zwischen 2012 und 2013 insgesamt 7998 KHK Patienten rekrutiert wurden. Sie enthält Informationen aus einem ambulanten Studienbesuch und aus einem Krankenhausaufenthalt aufgrund eines KHK-Ereignisses (Index). Am deutschen Studienzentrum in Würzburg wurden 536 Patienten eingeschlossen und die Qualität der Risikofaktorkontrolle nach den Empfehlungen der Europäischen Gesellschaft für Kardiologie untersucht. Chronische NI wurde in Stadien eingeteilt anhand von glomerulärer Filtrationsrate (eGFR) und Albuminurie. Zudem Am deutschen EUROASPIRE IV Studienzentrum wurden die Patienten zudem in einem zusätzlichen „Nieren-spezifischen Modul“ befragt, ob sie jemals von einem Arzt hinsichtlich einer Nierenerkrankung aufgeklärt wurden. Um das Bewusstsein für Nierenerkrankungen bei Ärzten einzuschätzen, wurde untersucht, ob akute oder chronische Nierenfunktionseinschränkungen im Arztbrief des Index-Aufenthaltes erwähnt wurden, und ob Nierenerkrankungen adäquat ICD-codiert waren. Die Mehrheit der deutschen KHK-Patienten wurde mit den empfohlenen Präparaten β-Blocker, Aspirin und Statinen behandelt, allerdings wurden die Ziel-/Grenzwerte für Blutdruck und Cholesterin oftmals nicht erreicht (45% bzw. 53%), ebenso wie die Blutzuckerkontrolle bei diabetischen Patienten (39%). Nur wenige Patienten waren aktive Raucher (10%), aber viele waren übergewichtig (85%) oder adipös (37%). Ältere Patienten erhielten seltener die empfohlenen Präparate und waren häufiger hypertensiv oder Diabetiker. Allerdings zeigten sich diabetische Patienten >70 Jahre besser kontrolliert und ältere Patienten waren seltener Raucher oder übergewichtig. Im Durchschnitt hatten 17% der KHK Patienten – mit großer Variation innerhalb der teilnehmenden Staaten – im EUROASPIRE IV Gesamtkollektiv eine chronische NI (eGFR <60 ml/min/1.73m²) und zusätzliche 10% hatten Albuminurie bei erhaltener eGFR. Eine eingeschränkte Nierenfunktion zeigte sich auch in jedem fünften Patienten bei Krankenhausaufnahme für das Index Ereignis im EUROASPIRE IV Gesamtkollektiv. Von den deutschen Patienten mit chronischer NI gab nur ein Drittel an, von ihrer Nierenfunktionseinschränkung zu wissen. Nur wenige dieser Patienten wurden von einem Nephrologen behandelt, wobei Patienten mit fortgeschrittener NI sich sowohl häufiger ihrer NI bewusst waren als auch von Spezialisten behandelt wurden. Im Index-Krankenhausaufenthalt hatte ein Drittel der Patienten wenigstens einen Hinweis auf eine entweder chronisch oder akut eingeschränkte Nierenfunktion. Lediglich in einem Fünftel war diese Diagnose im Entlassungsbrief erwähnt, während die Codierung nach Entlassung zwar vollständiger, aber immer noch lückenhaft war. Die Qualität der Sekundärprävention in deutschen KHK-Patienten lässt weiterhin beträchtlichen Raum für Verbesserung. Hierbei erscheinen die Veränderung im Lebensstil weitaus zielführender zu sein als die medikamentöse Therapie in definierte Zielbereiche. Die medizinische Therapie und die Herangehensweise an Verhaltensänderungen muss insbesondere bei älteren Patienten an die besondere Bedürfnisse dieser Patientengruppe angepasst werden. Chronische NI ist häufig bei KHK Patienten anzutreffen, nicht nur bei älteren Studienteilnehmern. KHK und chronische NI beeinflussen sich und die Prognose des jeweils anderen gegenseitig, sodass eine Steigerung des Bewusstseins für Nierenerkrankungen sowohl bei Patienten als auch bei Ärzten, und die Anpassung der Behandlungsstrategie womöglich zu einer Verbesserung der Prognose und zur Verlangsamung des Fortschreitens beider Erkrankungen, KHK und NI führen. KW - koronare Herzerkrankung KW - Sekundärprävention KW - Chronische Nierenerkrankung KW - coronary heart disease KW - secondary prevention KW - chronic kidney disease Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175498 ER - TY - JOUR A1 - Prugger, Christof A1 - Heidrich, Jan A1 - Wellmann, Jürgen A1 - Dittrich, Ralf A1 - Brand, Stefan-Martin A1 - Telgmann, Ralph A1 - Breithardt, Günter A1 - Reinecke, Holger A1 - Scheld, Hans A1 - Kleine-Katthöfer, Peter A1 - Heuschmann, Peter U. A1 - Keil, Ulrich T1 - Trends in Cardiovascular Risk Factors Among Patients With Coronary Heart Disease : Results From the EUROASPIRE I, II, and III Surveys in the Münster Region JF - Deutsches Ärzteblatt International N2 - Background: Target values for cardiovascular risk factors in patients with coronary heart disease (CHD) are stated in guidelines for the prevention of cardiovascular disease. We studied secular trends in risk factors over a 12-year period among CHD patients in the region of Munster, Germany. Methods: The cross-sectional EUROASPIRE I, II and III surveys were performed in multiple centers across Europe. For all three, the Munster region was the participating German region. In the three periods 1995/96, 1999/2000, and 2006/07, the surveys included (respectively) 392, 402 and 457 <= 70-year-old patients with CHD in Munster who had sustained a coronary event at least 6 months earlier. Results: The prevalence of smoking remained unchanged, with 16.8% in EUROASPIRE I and II and 18.4% in EUROASPIRE III (p=0.898). On the other hand, high blood pressure and high cholesterol both became less common across the three EUROASPIRE studies (60.7% to 69.4% to 55.3%, and 94.3% to 83.4% to 48.1%, respectively; p<0.001 for both). Obesity became more common (23.0% to 30.6% to 43.1%, p<0.001), as did treatment with antihypertensive and lipid-lowering drugs (80.4% to 88.6% to 94.3%, and 35.0% to 67.4% to 87.0%, respectively; p<0.001 for both). Conclusion: The observed trends in cardiovascular risk factors under-score the vital need for better preventive strategies in patients with CHD. KW - smoking-cessation KW - follow up KW - primary-care physicians KW - myocardial infarction KW - secondary prevention KW - clinical practice KW - European countries KW - drug therapies KW - life style KW - task force Y1 - 2012 U6 - https://doi.org/10.3238/arztebl.2012.0303 VL - 109 IS - 17 ER - TY - JOUR A1 - Gyberg, Viveca A1 - De Bacquer, Dirk A1 - De Backer, Guy A1 - Jennings, Catriona A1 - Kotseva, Kornelia A1 - Mellbin, Linda A1 - Schnell, Oliver A1 - Tuomilehto, Jaakko A1 - Wood, David A1 - Ryden, Lars A1 - Amouyel, Philippe A1 - Bruthans, Jan A1 - Conde, Almudena Castro A1 - Cifkova, Renata A1 - Deckers, Jaap W. A1 - De Sutter, Johan A1 - Dilic, Mirza A1 - Dolzhenko, Maryna A1 - Erglis, Andrejs A1 - Fras, Zlatko A1 - Gaita, Dan A1 - Gotcheva, Nina A1 - Goudevenos, John A1 - Heuschmann, Peter A1 - Laucevicius, Aleksandras A1 - Lehto, Seppo A1 - Lovic, Dragan A1 - Milicic, Davor A1 - Moore, David A1 - Nicolaides, Evagoras A1 - Oganov, Raphae A1 - Pajak, Andrzej A1 - Pogosova, Nana A1 - Reiner, Zeljko A1 - Stagmo, Martin A1 - Störk, Stefan A1 - Tokgözoglu, Lale A1 - Vulic, Dusko T1 - 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 JF - Cardiovascular Diabetology N2 - 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 (approximate to 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. KW - heart KW - glycaemic control KW - cardiovascular diseases KW - myocardial infarction KW - glucose control KW - blood-glucose KW - risk factors KW - follow-up KW - mellitus KW - mortality KW - guidelines KW - coronary artery disease KW - type 2 diabetes KW - secondary prevention KW - management KW - guideline adherence KW - blood pressure KW - blood lipids Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141358 VL - 14 IS - 133 ER -