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European Journal of Epidemiology

, Volume 34, Issue 3, pp 247–258 | Cite as

Incidence of cardiovascular events in patients with stabilized coronary heart disease: the EUROASPIRE IV follow-up study

  • Dirk De BacquerEmail author
  • Delphine De Smedt
  • Kornelia Kotseva
  • Catriona Jennings
  • David Wood
  • Lars Rydén
  • Viveca Gyberg
  • Bahira Shahim
  • Philippe Amouyel
  • Jan Bruthans
  • Almudena Castro Conde
  • Renata Cífková
  • Jaap W. Deckers
  • Johan De Sutter
  • Mirza Dilic
  • Maryna Dolzhenko
  • Andrejs Erglis
  • Zlatko Fras
  • Dan Gaita
  • Nina Gotcheva
  • John Goudevenos
  • Peter Heuschmann
  • Aleksandras Laucevicius
  • Seppo Lehto
  • Dragan Lovic
  • Davor Miličić
  • David Moore
  • Evagoras Nicolaides
  • Raphael Oganov
  • Andrzej Pajak
  • Nana Pogosova
  • Zeljko Reiner
  • Martin Stagmo
  • Stefan Störk
  • Lale Tokgözoğlu
  • Dusko Vulic
  • Martin Wagner
  • Guy De Backer
  • On behalf of the EUROASPIRE Investigators
CARDIOVASCULAR DISEASE

Abstract

The EUROASPIRE surveys (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) demonstrated that most European coronary patients fail to achieve lifestyle, risk factor and therapeutic targets. Here we report on the 2-year incidence of hard cardiovascular (CV) endpoints in the EUROASPIRE IV cohort. EUROASPIRE IV (2012–2013) was a large cross-sectional study undertaken at 78 centres from selected geographical areas in 24 European countries. Patients were interviewed and examined at least 6 months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1 year after this baseline screening were registered. The primary outcome in our analyses was the incidence of CV death or non-fatal myocardial infarction, stroke or heart failure. Cox regression models, stratified for country, were fitted to relate baseline characteristics to outcome. Our analyses included 7471 predominantly male patients. Overall, 222 deaths were registered of whom 58% were cardiovascular. The incidence of the primary outcome was 42 per 1000 person-years. Comorbidities were strongly and significantly associated with the primary outcome (multivariately adjusted hazard ratio HR, 95% confidence interval): severe chronic kidney disease (HR 2.36, 1.44–3.85), uncontrolled diabetes (HR 1.89, 1.50–2.38), resting heart rate ≥ 75 bpm (HR 1.74, 1.30–2.32), history of stroke (HR 1.70, 1.27–2.29), peripheral artery disease (HR 1.48, 1.09–2.01), history of heart failure (HR 1.47, 1.08–2.01) and history of acute myocardial infarction (HR 1.27, 1.05–1.53). Low education and feelings of depression were significantly associated with increased risk. Lifestyle factors such as persistent smoking, insufficient physical activity and central obesity were not significantly related to adverse outcome. Blood pressure and LDL-C levels appeared to be unrelated to cardiovascular events irrespective of treatment. In patients with stabilized CHD, comorbid conditions that may reflect the ubiquitous nature of atherosclerosis, dominate lifestyle-related and other modifiable risk factors in terms of prognosis, at least over a 2-year follow-up period.

Keywords

Coronary heart disease Guidelines implementation Secondary prevention 

Notes

Acknowledgements

The EUROASPIRE IV survey was carried out under the auspices of the European Society of Cardiology, EURObservational Research Programme. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript. The EUROASPIRE Study Group is grateful to the administrative staff, physicians, nurses and other personnel in the hospitals in which the survey was carried out and to all patients who participated in the surveys.

Funding

This work was supported by AstraZeneca, Bristol–Myers Squibb/Emea Sarl, GlaxoSmithKline, F Hoffman–La Roche (Gold Sponsors), Merck, Sharp and Dohme and Amgen (Bronze Sponsors) (unrestricted research grants to the European Society of Cardiology).

Compliance with ethical standards

Conflict of interest

(1) KK, DDB, CJ, VG, LR and DW had grant support from the European Society of Cardiology for the submitted work; VG was supported by a Grant from the Swedish Heart and Lung Foundation; AP was supported by a grant from the Polish National Science Centre (Contract DEC-2011/03/B/N27/06101); JB was supported by the Grant No. NT 13186 by the Internal Grant Agency, Ministry of Health, Czech Republic; DM had grants from Servier, MSD, Sanofi-Aventis, Menarini; PA had grants from AstraZeneca; SS had grants from German Ministry of Research and Education via the Comprehensive Heart Failure Centre, University of Würzburg; (2) DW, LR, KK, VG, PA, MD, MS, PH, RC, AE, DG, ZR, LT had the following financial activities outside the submitted work in the previous 3 years: DW, honoraria for invited lectures or advisory boards: AstraZeneca, Merck Sharp and Dohme, Kowa Pharmaceuticals, Menarini, Zentiva; consultancy: Merck Sharp and Dohme; LR, Grants from Swedish Heart Lung Foundation, Swedish Diabetes Association, Roche AG, Bayer AG and Karolinska Institute Funds, personal fees from Roche, SanofiAventis, and Bayer AG; KK, travel Grants from Roche and Boehringer Ingelheim; VG, lecture fees from MSD Sweden; PA had grants and personal fees from Fondation Plan Alzheimer, Servier, Alzprotect, Total, Hoffman Roche, Daichi Sankyo, Genoscreen; MD, grants from Universal Agency ‘Profarma’; MS was temporarily employed by MSD Sweden AB as Associate Director, medical affairs, during part of the study period; PH receives/received in the recent years research support from the German Ministry of Research and Education (Centre for Stroke Research Berlin; Comprehensive Heart Failure Centre Würzburg), the European Union (European Implementation Score Collaboration), the German Stroke Foundation, the Charité—Universitätsmedizin Berlin, the Berlin Chamber of Physicians, and the University Hospital of Würzburg; RC had grants from Krka, Novo Mesto, Slovenia, personal fees from Servier International, Medtronic, Medtronic Czechia, Abbott Products Operations AG, MSD Czech Republic, TEVA Pharmaceuticals Czech Republic; ZR had personal fees from Sanofi, AstraZeneca, Abbott, and Aegirion; AE had grants and personal fees from Abbott Vascular, Boston Scientific, Biosensors, Biotronik, Cordis J&J, Medtronik; DG had personal fees from AstraZaneca, Abbott, Novartis and Sanofi; LT had lecture honoraria from Abbott, MSD, Bayer, AstraZaneca, Boehringer Ingelheim, Pfizer, Sanofi, Servier, Kowa and Actelion, and (3) ACC, JWD, JDS, MD, ZF, DL, NG, AL, DL, EN, RO, NP, DV have no financial interests that are relevant to the submitted work.

Supplementary material

10654_2018_454_MOESM1_ESM.docx (107 kb)
Supplementary material 1 (DOCX 107 kb)

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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Dirk De Bacquer
    • 1
    Email author
  • Delphine De Smedt
    • 1
  • Kornelia Kotseva
    • 1
    • 2
  • Catriona Jennings
    • 2
  • David Wood
    • 2
  • Lars Rydén
    • 3
  • Viveca Gyberg
    • 3
  • Bahira Shahim
    • 3
  • Philippe Amouyel
    • 4
  • Jan Bruthans
    • 5
  • Almudena Castro Conde
    • 6
  • Renata Cífková
    • 5
  • Jaap W. Deckers
    • 7
  • Johan De Sutter
    • 8
  • Mirza Dilic
    • 9
  • Maryna Dolzhenko
    • 10
  • Andrejs Erglis
    • 11
  • Zlatko Fras
    • 12
  • Dan Gaita
    • 13
  • Nina Gotcheva
    • 14
  • John Goudevenos
    • 15
  • Peter Heuschmann
    • 16
    • 17
  • Aleksandras Laucevicius
    • 18
    • 19
  • Seppo Lehto
    • 20
  • Dragan Lovic
    • 21
  • Davor Miličić
    • 22
  • David Moore
    • 23
  • Evagoras Nicolaides
    • 24
  • Raphael Oganov
    • 25
  • Andrzej Pajak
    • 26
  • Nana Pogosova
    • 27
  • Zeljko Reiner
    • 22
  • Martin Stagmo
    • 28
  • Stefan Störk
    • 29
  • Lale Tokgözoğlu
    • 30
  • Dusko Vulic
    • 31
  • Martin Wagner
    • 16
    • 17
  • Guy De Backer
    • 1
  • On behalf of the EUROASPIRE Investigators
  1. 1.Department of Public HealthGhent UniversityGhentBelgium
  2. 2.International Centre for Circulatory Health, National Heart and Lung InstituteImperial College LondonLondonUK
  3. 3.Cardiology Unit, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
  4. 4.Institut Pasteur de LilleUniversité de LilleLilleFrance
  5. 5.Centre for Cardiovascular Prevention, 1st Medical FacultyCharles University and Thomayer HospitalPragueCzech Republic
  6. 6.Cardiac Rehabilitation Unit, Cardiology DepartmentHospital Universitario La PazMadridSpain
  7. 7.Department of CardiologyThoraxcentreRotterdamThe Netherlands
  8. 8.Department of Internal MedicineGhent UniversityGhentBelgium
  9. 9.Clinical Centre University of SarajevoSarajevoBosnia and Herzegovina
  10. 10.Department of CardiologyShupyk’s National Medical Academy of Postgraduate EducationKievUkraine
  11. 11.Pauls Stradins Clinical University HospitalUniversity of LatviaRigaLatvia
  12. 12.University Medical CentreLjubljanaSlovenia
  13. 13.Institutul de Boli CardiovasculareUniversitatea de Medicina si Farmacie ‘Victor Babes’TimisoaraRomania
  14. 14.Department of CardiologyNational Heart HospitalSofiaBulgaria
  15. 15.Cardiology Department of Medical SchoolUniversity of IoanninaIoanninaGreece
  16. 16.Institute of Clinical Epidemiology and BiometryUniversity of WürzburgWürzburgGermany
  17. 17.Clinical Trial Centre WürzburgUniversity Hospital WürzburgWürzburgGermany
  18. 18.Clinic of Cardiovascular DiseasesVilnius UniversityVilniusLithuania
  19. 19.Heart and Vascular MedicineVilnius University Hospital Santariskiu ClinicsVilniusLithuania
  20. 20.Kuopio University HospitalKuopioFinland
  21. 21.Clinic for Internal Medicine IntermedicaNisSerbia
  22. 22.University Hospital Centre Zagreb, School of MedicineUniversity of ZagrebZagrebCroatia
  23. 23.The Adelaide and Meath HospitalDublinIreland
  24. 24.Nicosia General HospitalUniversity of Nicosia Medical SchoolNicosiaCyprus
  25. 25.National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian FederationMoscowRussia
  26. 26.Department of Epidemiology and Population Studies, Faculty of Health SciencesJagiellonian University Medical CollegeKracowPoland
  27. 27.Federal Health Centre and Department of Chronic Noncommunicable Diseases PreventionNational Research Centre for Preventive MedicineMoscowRussia
  28. 28.Department of Heart Failure and Valve DiseaseSkåne University HospitalLundSweden
  29. 29.Comprehensive Heart Failure Centre and Department of Medicine IUniversity of WürzburgWürzburgGermany
  30. 30.Hacettepe UniversityAnkaraTurkey
  31. 31.Centre for Medical Research, School of MedicineUniversity of Banja LukaBanja LukaBosnia and Herzegovina

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