TY - THES A1 - Tiffe, Theresa T1 - Prävalenz und Determinanten für die Einhaltung der leitliniengerechten Therapie kardiovaskulärer Risikofaktoren in der Primär- und Sekundärprävention von Herz-Kreislauf-Erkrankungen in Deutschland T1 - Prevalence and determinants for compliance to guidelines recommendations for therapy of cardiovascular risk factors in primary and secondary prevention of cardiovascular diseases in Germany N2 - Die Einhaltung eines gesunden Lebensstils, einschließlich der Behandlung modifizierbarer kardiovaskulärer Risikofaktoren, beeinflusst maßgeblich die Entstehung und Progression von Herz-Kreislauf-Erkrankungen (HKE). So reduziert eine ausgewogene Ernährungsweise, ausreichend körperliche Aktivität, Tabakverzicht, das Halten des Normalgewichtes sowie die Behandlung einer Hypertonie, Hyperlipidämie und Diabetes mellitus, die kardiovaskuläre Morbidität und Mortalität. Die vorliegende Arbeit widmet sich (a) der Prävalenz und leitliniengerechten Kontrolle kardiovaskulärer Risikofaktoren von Teilnehmern aus der Allgemeinbevölkerung der STAAB Kohortenstudie („Häufigkeit und Einflussfaktoren auf frühe Stadien A und B der Herzinsuffizienz in der Bevölkerung“) sowie der Schätzung des 10-Jahres Risikos für tödliche HKE in diesem Kollektiv. Weiterhin wurde (b) der Einfluss von medikamentenbezogenen Überzeugungen auf die Blutdruckkontrolle von Teilnehmern der STAAB Kohortenstudie untersucht. Schließlich wurde (c) der Erhalt von ärztlichen Lebensstilempfehlungen sowie deren Determinanten bei Teilnehmern der STAAB Kohortenstudie sowie der EUROASPIRE IV Studie („European Action on Secondary and Primary Prevention by Intervention to Reduce Events“) in Deutschland betrachtet. Die STAAB Kohortenstudie untersucht die frühen asymptomatischen Formen der Herzinsuffizienz-Stadien A und B in einer repräsentativen Stichprobe von 5.000 Personen ohne symptomatische Herzinsuffizienz im Alter von 30 bis 79 Jahren aus der Allgemeinbevölkerung mit Wohnsitz in der Stadt Würzburg. Die EUROASPIRE IV Studie untersuchte bei 7.998 Koronarpatienten im Alter von 18 bis 79 Jahren aus insgesamt 24 Europäischen Ländern (536 Patienten aus Deutschland) im Zeitraum 2012 bis 2013 die Risikofaktoren sowie die Umsetzung der leitliniengerechten Versorgung und Prävention von HKE im europäischen Vergleich. Die Datenerhebung beider Studien erfolgte durch ein geschultes Studienpersonal nach standardisierten Vorgaben. Die Prävalenz und Kontrolle kardiovaskulärer Risikofaktoren nach den aktuellen Vorgaben der „European Society of Cardiology“ (ESC) wurde bei insgesamt 1.379 Teilnehmern, die zwischen Dezember 2013 und April 2015 an der STAAB Kohortenstudie teilgenommen haben, untersucht. Es zeigte sich eine hohe Prävalenz der kardiovaskulären Risikofaktoren Hypertonie (31.8%), Hyperlipidämie (57.6%) und Diabetes mellitus (3.5%). Hierbei erreichten trotz Pharmakotherapie über die Hälfte der Teilnehmer mit einem Bluthochdruck (52.7%) oder erhöhten LDL-Cholesterinwerten (56.7%) sowie 44.0% der Personen mit einem Diabetes mellitus die empfohlenen Grenzwerte nicht. Weiterhin wurde erstmalig zu Studienbesuch eine Hypertonie (36.0%), Hyperlipidämie (54.2%) oder ein Langzeitzuckerwert (HbA1c) >6.5% (23.3%) detektiert. In der jüngsten Altersgruppe (30-39 Jahre) fand sich der höchste Anteil von unbekanntem Bluthochdruck (76.5%) sowie hohem LDL-Cholesterin (78.0%) und die Altersgruppe 60-69 Jahren wies mit 43.5% die höchste Prävalenz für einen bislang nicht detektierten HbA1c >6.5% auf. Die Akkumulation von drei oder mehr kardiovaskulären Risikofaktoren war mit dem männlichen Geschlecht, einem höheren Alter und einem niedrigeren Bildungsgrad assoziiert. Von 980 mittels SCORE („Systematic Coronary Risk Evaluation“) Risiko-Chart untersuchten Teilnehmern befanden sich jeweils 56.6%, 35.8% und 7.5% in der niedrigen, mittleren und hohen bis sehr hohen SCORE-Risikogruppe für tödliche HKE. Das Hochrisiko-Kollektiv für tödliche HKE war vorwiegend männlich und wies häufiger eine Hypertonie oder ein hohes LDL-Cholesterin auf. Der Einfluss von Überzeugungen gegenüber antihypertensiver Medikation auf die Blutdruckkontrolle wurde an 293 Teilnehmern, die von Oktober 2014 bis März 2017 an der STAAB Kohortenstudie teilgenommen haben, untersucht. Auf ihre Medikamente gesundheitlich angewiesen zu sein gaben 87% der Teilnehmer an, 78.1% stimmten der Aussage zu, dass ihre Medikamente sie vor einer Verschlechterung ihrer Gesundheit schützen. Es zeigte sich ein inverser Zusammenhang zwischen einem höheren Maß an Bedenken gegenüber der verordneten blutdrucksenkenden Medikation und einer besseren Blutdruckkontrolle bei Frauen. Ein signifikanter Zusammenhang zwischen Bedenken gegenüber einer antihypertensiven Medikation und der Blutdruckkontrolle bei Männern ließ sich hingegen nicht feststellen. Es konnten keine statistisch signifikanten Assoziationen für die Notwendigkeit von Medikation in der vorliegen Untersuchung gezeigt werden. Die Häufigkeit und Determinanten für die Empfehlung eines ärztlichen Lebensstils wurde bei 665 Teilnehmern der STAAB Kohortenstudie ohne vorbestehende HKE (Primärprävention) und bei 536 Koronarpatienten der EUROASPIRE IV Studie (Sekundärprävention) untersucht. Mit Ausnahme der Empfehlung zum Rauchverzicht erhielten die Patienten der EUROASPIRE IV Studie häufiger ärztliche Lebensstilempfehlungen verglichen mit Teilnehmern der STAAB Kohortenstudie: (Rauchverzicht: STAAB 44.0%, EUROASPIRE 36.7%; Gewichtsreduktion: STAAB 43.9%, EUROASPIRE 69.2%; körperliche Aktivität steigern: STAAB 52.1%, EUROASPIRE 71.4%; gesundes Ernährungsverhalten: STAAB 43.9%, EUROASPIRE 73.1%). Die Chance für den Erhalt von mindestens 50% aufgrund der individuellen Risikofaktoren adäquaten ärztlichen Lebensstilempfehlungen war bei STAAB Teilnehmern mit offensichtlichen oder beobachtbaren kardiovaskulären Risikofaktoren signifikant erhöht (BMI >25kg/m2, Hypertonie, Hyperlipidämie und Diabetes mellitus). Hingegen erhielten Patienten mit einer vorbestehenden HKE signifikant häufiger eine ärztliche Lebensstilempfehlung bei einem Diabetes mellitus, wobei die Empfehlungshäufigkeit mit zunehmendem Alter abnahm. Die weitergehende nicht publizierte Analyse des Interaktions Modells zeigte, dass der Zusammenhang zwischen dem Alter und der Empfehlungshäufigkeit bei Patienten mit bereits bestehender HKE stärker ausgeprägt war, als bei Teilnehmern der STAAB Kohortenstudie ohne koronare HKE. Weiterhin war der Zusammenhang zwischen einer adäquaten Lebensstilempfehlung und Hyperlipidämie bei Teilnehmern ohne koronares Ereignis signifikant stärker ausgeprägt, im Vergleich zu Patienten mit einer bereits bestehender HKE. Die Ergebnisse zeigten ein erhebliches Potenzial für eine verbesserte Umsetzung leitliniengerechter Behandlung modifizierbarer kardiovaskulärer Risikofaktoren in der Primär- und Sekundärprävention. Vor dem Hintergrund einer hohen Anzahl kardiovaskulärer Risikofaktoren bei jungen Erwachsenen sollte die Bedeutung der Langzeitfolgen im Arzt Patienten-Gespräch hervorgehoben und bei der Erarbeitung von Präventionsstrategien, insbesondere für junge Altersgruppen, Beachtung finden. Geschlechtsspezifische Determinanten hinsichtlich der Kontrolle kardiovaskulärer Risikofaktoren sowie Befürchtungen gegenüber der Medikation sollten stärker im Arzt-Patientengespräch berücksichtigt werden. Zur Stärkung der Compliance des Patienten bei der Umsetzung eines gesunden Lebensstils, sollte der Arzt hinsichtlich der Bedeutung von Lebensstilintervention, aber auch im Umgang mit schwierigen Situationen, wie die Empfehlung einer Gewichtsreduktion, sensibilisiert und bei der richtigen Handhabung der Leitlinienempfehlung stärker unterstützt werden. N2 - Maintaining a healthy lifestyle, including the treatment of modifiable cardiovascular risk factors, has a significant impact on the development and progression of cardiovascular diseases (CVD). Thus, a healthy diet, adequate physical activity, tobacco control, maintaining normal weight and the treatment of hypertension, hyperlipidemia and diabetes mellitus, reduce cardiovascular morbidity and mortality. The present work focused on (a) the prevalence and guideline-recommended control of cardiovascular risk factors from the general population of the STAAB cohort study (Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression) and their estimation of the 10-year risk of fatal CVD. Furthermore, we investigated, (b) the influence of medication-related beliefs on blood pressure control from participants of the STAAB cohort study. Finally, we considered (c) the maintenance of physicians-led lifestyle recommendations and their determinants in the STAAB cohort study compared to the EUROASPIRE IV study (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) in Germany. The STAAB cohort study examines the early asymptomatic forms of heart failure stages A and B in a representative sample of 5.000 participants aged 30 to 79 years of the general population of the city of Würzburg. The EUROASPIRE IV study examined 7.998 patients with CVD aged 18 to 79 years from a total of 24 European countries between 2012 to 2013, including 536 patients from Germany. The Study investigated the prevalence of cardiovascular risk factors as well as the guideline recommended control care in coronary patients. The data collection of both studies was performed by trained staff according to standardized operating procedures. The prevalence and control of cardiovascular risk factors according to the current guidelines of the European Society of Cardiology (ESC) was investigated in 1.379 participants who participated in the STAAB cohort study between December 2013 and April 2015. A high prevalence of hypertension (31.8%), hyperlipidemia (57.6%) and diabetes mellitus (3.5%) was observed. Despite pharmacotherapy, more than half of the participants with high blood pressure (52.7%) or elevated LDL cholesterol levels (56.7%) as well as 44.0% of the persons with diabetes mellitus failed to reach the targets recommended in clincial guidelines. Furthermore, hypertension, hyperlipidemia and an HbA1c-level >6.5% was detected for the first time during study visit in 36.0%, 54.2% and 23.3%, respectively. The highest proportion of unknown cardiovascular risk factors was found in the youngest age group (30-39 years) for high blood pressure (76.5%), high LDL cholesterol (78.0%), and in the age group of 60-69 years for an undetected HbA1c-level of >6.5%. The accumulation of three or more cardiovascular risk factors was associated with male gender, higher age and educational level. Of 980 participants of the STAAB cohort study, 56.6%, 35.8%, and 7.5% were in the low, middle, and high to very high risk group for fatal CHD according to the SCORE risk chart. Participants with a high to very high SCORE risk group were predominantly male and demonstrated a higher prevalence of hypertension or high LDL cholesterol. The influence of medication-related beliefs on blood pressure control was investigated in 293 participants who participated in the STAAB cohort study from October 2014 to March 2017. Eighty-seven percent of these participants stated that „I sometimes worry about becoming too dependent on my medicines“, followed by the statement „My medicines protect me from becoming worse“ worse (78.1%). There was an inverse association between a higher level of concern about the prescribed antihypertensive medication and a better blood pressure control in women. However, there was no statistically significant association between concerns about antihypertensive medication and blood pressure control in men. No statistically significant associations were found for the necessity of prescribed medication in any model. The prevalence and determinants for healthy lifestyle advices by physicians were investigated in 665 participants of the STAAB cohort study without previous CVD (primary prevention) and in 536 coronary patients of the EUROASPIRE IV study (secondary prevention). Except for smoking, patients in EUROASPIRE IV received more frequently healthy lifestyle advices than participants in the STAAB cohort study (smoking abstinence: STAAB 44.0%, EUROASPIRE 36.7%; weight reduction: STAAB 43.9%, EUROASPIRE 69.2%; physical activity: STAAB 52.1%, EUROASPIRE 71.4%; healthy diet: STAAB 43.9%, EUROASPIRE 73.1%). In addition, patients with a pre-existing CVD received significantly more lifestyle advices for diabetes mellitus, whereas the frequency of lifestyle recommendations decreased with advancing age. The analysis of the interaction model showed that the correlation between age and receiving adequate lifestyle advices was more pronounced in patients with existing CVD than in participants without coronary CVD in the STAAB cohort study. Furthermore, the relationship between receiving adequate lifestyle advices and hyperlipidemia was significantly stronger in participants without a coronary event compared to patients with existing CVD. Present results show a considerable potential for improved implementation of guideline recommended control of modifiable cardiovascular risk factors in primary and secondary prevention. Due to the high number of cardiovascular risk factors in young adults, the importance of long-term consequences of cardiovascular risk factors should be emphasized in physician-patient conversation and taken into account in the development of prevention strategies, especially for younger age groups. Gender-specific determinants regarding the control of cardiovascular risk factors as well as concerns about medication should be given greater consideration in the physician-patient interaction. In order to strengthen the patients compliance of a healthy lifestyle, physicians should be sensitized with regard to the importance of healthy lifestyle advices, but also in dealing with difficult situations, such as the recommendation of weight reduction. Also the correct handling of the guideline recommendations by physicians should be more supported. KW - Kardiovaskuläre Krankheit KW - Herz-Kreislauf-Erkrankung KW - kardiovaskuläre Risikofaktoren KW - Prävention Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-192723 ER - TY - JOUR A1 - Müller-Scholden, Lara A1 - Kirchhof, Jan A1 - Morbach, Caroline A1 - Breunig, Margret A1 - Meijer, Rudy A1 - Rücker, Viktoria A1 - Tiffe, Theresa A1 - Yurdadogan, Tino A1 - Wagner, Martin A1 - Gelbrich, Götz A1 - Bots, Michiel L. A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Segment-specific association of carotid-intima-media thickness with cardiovascular risk factors – findings from the STAAB cohort study JF - BMC Cardiovascular Disorders N2 - Background The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors. Methods Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from Würzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT. Results 2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA. Conclusions As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual. KW - Carotid intima-media thickness (CIMT) KW - Carotid segment KW - Carotid ultrasound KW - Cardiovascular risk factors KW - Cardiovascular risk prediction Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200720 VL - 19 IS - 84 ER - TY - JOUR A1 - Tiffe, Theresa A1 - Morbach, Caroline A1 - Rücker, Viktoria A1 - Gelbrich, Götz A1 - Wagner, Martin A1 - Faller, Hermann A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study JF - International Journal of Hypertension N2 - Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences. KW - hypertension Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200992 VL - 2019 ER - TY - JOUR A1 - Tiffe, Theresa A1 - Wagner, Martin A1 - Rücker, Viktoria A1 - Morbach, Caroline A1 - Gelbrich, Götz A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Control of cardiovascular risk factors and its determinants in the general population – findings from the STAAB cohort study JF - BMC Cardiovascular Disorders N2 - Background: While data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD). Methods: Data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed. Results: Between December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11). Conclusions: In the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population. KW - population-based study KW - prevalence KW - risk factor control KW - guideline adherence KW - primary prevention Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159391 VL - 17 IS - 276 ER - TY - JOUR A1 - Sahiti, Floran A1 - Morbach, Caroline A1 - Cejka, Vladimir A1 - Tiffe, Theresa A1 - Wagner, Martin A1 - Eichner, Felizitas A. A1 - Gelbrich, Götz A1 - Heuschmann, Peter U. A1 - Störk, Stefan T1 - Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study JF - Journal of Human Hypertension N2 - Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops, and has been validated against invasively derived pressure-volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of Würzburg, Germany, aged 30-79 years. Indices of myocardial work were determined in 1929 individuals (49.3% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease. KW - myocardial work KW - left ventricular performance KW - cardiovascular risk factors Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-271770 SN - 1476-5527 VL - 36 IS - 3 ER -