A11742 Continous improvement of treatable cardiovascular risk factors control in secondary prevention of established coronary heart disease.

Abstract

Objectives: In established CHD the prevention guidelines recommend random hypolipidemic treatment and control of blood pressure. However, even stronger mortality risk may present diabetes and even prediabetes. We analysed, how standing reccommendations are followed. Methods: Analysis of five independent surveys of patiens with stabilized manifest CHD performed in 1995 - 2017 (Czech samples of EUROASPIRE I, II, III, IV and V surveys), pts interviewed at least 6 months after hospitalization for acute coronary syndrome and/or revascularization). Results: 2098 pts investigated. 1995–2017 systolic BP decreased from144.1 to 132.5 mmHg (p < 0.001), diastolic BP from 87.5 to 80.3 mmHg (p < 0.001). Control of hypertension improved from 45 to 86%. Use of betablockers increased from 65.2 to 88.1%, of ACEI /sartans from 28.0 to 85.6%. Total cholesterol decreased from 5.41 to 4. 33 mmol/l (p < 0.0001), LDL cholesterol from 3.4 to 2.34 mmol/l (p < 0.0001). Hypolipidaemic drugs were used in 28.7% in 1995 and in 95.1% in 2017, statins in7.3 and 94.6 % respectively. Prevalence of diabetes (fasting glycaemia > 7 mmol/L or use of antidiabetic treatment) increased from 26% to53%. Diabetes carries in these patients, according to our follow up data, considerably higher mortality risk than elevated blood pressure or hypercholesterolaemia. Conclusion: Despite progress in control of high blood pressure and hypercholesteroleemia in patients with established CHD, prevalence of diabetes is increasing and diabetes carries higher mortality risk than elevated blood pressure or hypercholesterolemia