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      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

      1 , 2 , 1 , 3 , 1 , 3 , 1 , 4 , 1 , 5 , 1 , 6 ,   1 , 7 , 1 , 8 , 1 , 2 , 9 , 1 , 10 , 11 , 12 , 1 , 13 , 14 , 1 , 13 , 1 , 15 , 16 , 1 , 17 , 1 , 3 , 1 , 18 , 19 , 1 , 20 , 21 , 1 , 22 , 1 , 23 , 1 , 24 , 25 , 1 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 1 , 34 , 1 , 35 , 26 , 1 , 4 , 1 , 36 , 1 , 37 , 38 , 39 , 40 , 1 , 41 , 30 , 42 , 1 , 43 , 1 , 44 , 45 , 1 , 2 , 46 , on behalf of the EUROASPIRE Investigators*
      European Journal of Preventive Cardiology
      SAGE Publications

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          Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.

          As more interventions become available for the treatment of coronary heart disease (CHD), policy makers and health practitioners need to understand the benefits of each intervention, to better determine where to focus resources. This is particularly true when a patient with CHD quits smoking. To conduct a systematic review to determine the magnitude of risk reduction achieved by smoking cessation in patients with CHD. Nine electronic databases were searched from start of database to April 2003, supplemented by cross-checking references, contact with experts, and with large international cohort studies (identified by the Prospective Studies Collaboration). Prospective cohort studies of patients who were diagnosed with CHD were included if they reported all-cause mortality and had at least 2 years of follow-up. Smoking status had to be measured after CHD diagnosis to ascertain quitting. Two reviewers independently assessed studies to determine eligibility, quality assessment of studies, and results, and independently carried out data extraction using a prepiloted, standardized form. From the literature search, 665 publications were screened and 20 studies were included. Results showed a 36% reduction in crude relative risk (RR) of mortality for patients with CHD who quit compared with those who continued smoking (RR, 0.64; 95% confidence interval [CI], 0.58-0.71). Results from individual studies did not vary greatly despite many differences in patient characteristics, such as age, sex, type of CHD, and the years in which studies took place. Adjusted risk estimates did not differ substantially from crude estimates. Many studies did not adequately address quality issues, such as control of confounding, and misclassification of smoking status. However, restriction to 6 higher-quality studies had little effect on the estimate (RR, 0.71; 95% CI, 0.65-0.77). Few studies included large numbers of elderly persons, women, ethnic minorities, or patients from developing countries. Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD. This risk reduction appears to be consistent regardless of age, sex, index cardiac event, country, and year of study commencement.
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            EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries.

            The aim of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey was to determine whether the Joint European Societies' guidelines on cardiovascular prevention are being followed in everyday clinical practice and to describe the lifestyle, risk factor and therapeutic management in patients with coronary heart disease (CHD) in Europe. The EUROASPIRE III survey was carried out in 2006-2007 in 76 centres from selected geographical areas in 22 countries in Europe. Consecutive patients, with a clinical diagnosis of CHD, were identified retrospectively and then followed up, interviewed and examined at least 6 months after their coronary event. Thirteen thousand nine hundred and thirty-five medical records (27% women) were reviewed and 8966 patients were interviewed. At interview, 17% of patients smoked cigarettes, 35% were obese and 53% centrally obese, 56% had a blood pressure >or=140/90 mmHg (>or=130/80 in people with diabetes mellitus), 51% had a serum total cholesterol >or=4.5 mmol/l and 25% reported a history of diabetes of whom 10% had a fasting plasma glucose less than 6.1 mmol/l and 35% a glycated haemoglobin A1c less than 6.5%. The use of cardioprotective medication was: antiplatelets 91%; beta-blockers 80%; angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 71%; calcium channel blockers 25% and statins 78%. The EUROASPIRE III survey shows that large proportions of coronary patients do not achieve the lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention. Wide variations in risk factor prevalences and the use of cardioprotective drug therapies exist between countries. There is still considerable potential throughout Europe to raise standards of preventive care in order to reduce the risk of recurrent disease and death in patients with CHD.
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              Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes.

              Although preventive drug therapy is a priority after acute coronary syndrome, less is known about adherence to behavioral recommendations. The aim of this study was to examine the influence of adherence to behavioral recommendations in the short term on risk of cardiovascular events. The study population included 18 809 patients from 41 countries enrolled in the Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5 randomized clinical trial. At the 30-day follow-up, patients reported adherence to diet, physical activity, and smoking cessation. Cardiovascular events (myocardial infarction, stroke, cardiovascular death) and all-cause mortality were documented to 6 months. About one third of smokers persisted in smoking. Adherence to neither diet nor exercise recommendations was reported by 28.5%, adherence to either diet or exercise by 41.6%, and adherence to both by 29.9%. In contrast, 96.1% of subjects reported antiplatelet use, 78.9% reported statin use, and 72.4% reported angiotensin-converting enzyme/angiotensin receptor blocker use. Quitting smoking was associated with a decreased risk of myocardial infarction compared with persistent smoking (odds ratio, 0.57; 95% confidence interval, 0.36 to 0.89). Diet and exercise adherence was associated with a decreased risk of myocardial infarction compared with nonadherence (odds ratio, 0.52; 95% confidence interval, 0.4 to 0.69). Patients who reported persistent smoking and nonadherence to diet and exercise had a 3.8-fold (95% confidence interval, 2.5 to 5.9) increased risk of myocardial infarction/stroke/death compared with never smokers who modified diet and exercise. Adherence to behavioral advice (diet, exercise, and smoking cessation) after acute coronary syndrome was associated with a substantially lower risk of recurrent cardiovascular events. These findings suggest that behavioral modification should be given priority similar to other preventive medications immediately after acute coronary syndrome. Clinical Trial Registration Information- URL: http://clinicaltrials.gov/ct2/show/NCT00139815. Unique identifier: NCT00139815.

                Author and article information

                European Journal of Preventive Cardiology
                Eur J Prev Cardiolog
                SAGE Publications
                February 10 2019
                February 10 2019
                : 204748731882535
                [1 ]European Society of Cardiology, Sophia Antipolis, France
                [2 ]National Heart and Lung Institute, Imperial College London, UK
                [3 ]Department of Public Health and Primary Care, Ghent University, Belgium
                [4 ]Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
                [5 ]Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
                [6 ]Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
                [7 ]ANMCO Research Centre, Florence, Italy
                [8 ]Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
                [9 ]Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
                [10 ]Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
                [11 ]Clinic of Cardiac and Vascular diseases, Medical Faculty, Vilnius University, Lithuania
                [12 ]Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
                [13 ]Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
                [14 ]Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
                [15 ]Department of Cardiology, Galway University Hospital and Croí, the West of Ireland Cardiac and Stroke Foundation, Croí Heart and Stroke Centre, Galway, Ireland
                [16 ]School of Public Health, Public Health Research Centre, Kazakh National Medical University, Almaty, Kazakhstan
                [17 ]Erasmus MC, Rotterdam, The Netherlands
                [18 ]Department of Internal Medicine and Paediatrics, Ghent University, Belgium
                [19 ]AZ Maria Middelares Ghent, Belgium
                [20 ]Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
                [21 ]Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
                [22 ]Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
                [23 ]Pauls Stradins Clinical University Hospita, University of Latvia, Riga, Latvia
                [24 ]Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
                [25 ]Medical Faculty, University of Ljubljana, Slovenia
                [26 ]Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
                [27 ]National Heart Hospital, Dept Cardiology, Sofia, Bulgaria
                [28 ]Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
                [29 ]Clinical Trial Centre, University Hospital Würzburg, Germany
                [30 ]Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
                [31 ]Assiut University Heart Hospital, Cardiovascular Medicine Department, Egypt
                [32 ]Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
                [33 ]Department for Metabolic Disorder, Intensive Treatment and Cell Therapy in Diabetes, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
                [34 ]Varkaus Hospital, Finland
                [35 ]Clinic for Internal Disease Intermedic, Cardiology Department, Hypertension Centre, Nis, Serbia
                [36 ]University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia
                [37 ]Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
                [38 ]National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
                [39 ]National Research Centre for Preventive Medicine, Directorate, Moscow, Russia
                [40 ]Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
                [41 ]University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
                [42 ]Department of Medicine I, University Hospital Würzburg, Germany
                [43 ]Department of Cardiology, Hacettepe University, Ankara, Turkey
                [44 ]First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece
                [45 ]Centre for Medical Research, School of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
                [46 ]National University of Ireland, Galway, Ireland *Listed in Supplemental Appendix
                © 2019




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