Preventive Cardiology Programme Research Articles

The importance of family nurses' participation in the local program of cardiological prevention in Wroclaw

Abstract In Poland, cardiac prevention programs minimize the nurse's role in health education related the patient's lifestyle change. Following the experience of Swedish primary health care, the Health Department of the City Hall in Wrocław was the first local government to launch a long-term, ten-year preventive cardiology program in 1998. Aim of the study To present the participation of family nurses in the implementation of population intervention program in cardiological prevention among the inhabitants of Wrocław. Material and method The general practitioners from Wrocław and a group of 100 family nurses participated in the preventative program. The overall goal of the program was to assess risk factors for cardiovascular disease. Each patient was provided with education by the nurse. To conduct the nursing visit, a procedure was used that took into account the structure criteria and the a unified procedure criteria. The nurses analyzed the norms of laboratory test results, blood pressure, heart rate, weight, height, fiber and fat intake, and calculated BMI and WHR. The nurses used a health profile. If a patient was considered a person from a higher risk group, they provided referred the patient to a general practitioner. Conclusions In local prevention program, residents were motivated to modify health behaviors through nursing diagnosis and assessment. The close place of residence and direct contact with the patient made it possible to provide health education focused on first-degree prevention. However, patient health education requires organization, time and communication skills, which is why it is so important to prepare staff to implement preventive programs and finance them from local funds. The new role of a health educator becomes an opportunity to change the perception of the traditional role of nursing.

Comparison of virtual vs face-to-face medical nutrition therapy in patients with hyperlipidemia

Since the COVID-19 pandemic, utilization of telemedicine visits has increased. The outcomes of virtual compared to face-to-face (F2F) visits for treating hyperlipidemia are uncharacterized. This observational study compared pre- to post-visit change in lipid markers between 41 virtual and 151 F2F visits with a registered dietitian nutritionist at the University of Michigan Preventive Cardiology program from 3/31/2019–9/31/2022. Total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected pre- and post-visit with a median 33 days between collections. Low-density lipoprotein (LDL-C) was calculated using the Sampson equation. We used paired T-tests to evaluate mean change in lipid markers for each visit type between pre and post timepoints, and linear regression to compare virtual to F2F visits. There was a significant decrease in TC, LDL-C, and non-HDL-C for both visit types. There was no significant difference in mean change in lipid markers between virtual and F2F visits. Telehealth is a promising strategy for increasing access to medical nutrition therapy.

The Effect of Partners on Smoking Cessation Among Patients with Cardiovascular Disease

Background/Aims Patients with or at high risk of developing cardiovascular disease often continue smoking, despite being medically advised to quit. Comprehensive preventive cardiology interventions, including behavioural strategies and support mechanisms among partners, can be effective in smoking cessation. This study aimed to evaluate the influence of partners on the ability of patients with a high cardiovascular risk who smoke to achieve a smoke-free lifestyle. Methods A retrospective analysis of pre-existing data collected within preventative cardiology programmes (EUROACTION, EUROACTION plus, MyAction Westminster and MyAction Galway) was conducted. The success rate for quitting smoking among patients at high risk of cardiovascular disease and their partners was measured at the end of the programme. Results A total of 222 patients and their partners attended the initial assessment and the end-of-programme visits. At initial assessment, none of the patients and 55% of the partners met the European goal of smoking abstinence, while at end of the programme, 64% of patients and 75% of partners sustained abstinence. The probability of quitting smoking at 16 weeks was significantly higher (4.76) among couples who tried to quit together (P<0.001). Conclusions During preventive cardiology programmes, having the support of a partner could help patients to achieve smoking abstinence. Efforts to support patients to quit smoking should include partners where possible.

Coronary risk reduction intervention for siblings and offspring of patients with premature coronary heart disease: the CRISO study protocol for a randomised controlled pilot study

BackgroundResearch has consistently demonstrated that preventive cardiology programs have limited success, and healthy practices among high-risk individuals remain suboptimal. Furthermore, there are no current programmes in Malta that offer support to first-degree relatives of patients with premature coronary heart disease. This internal pilot study will determine the feasibility, acceptability, and potential effectiveness of a preventative intervention.Methods/designWe are conducting a 12-month single-centre, two-armed group randomised controlled trial (RCT), recruiting a sample of 100 asymptomatic first-degree relatives of patients with premature coronary heart disease (CHD). The study seeks to test an evidence-based intervention to reduce modifiable risk and determine its feasibility and acceptability. The Intervention will be delivered at an outpatient office based in a large acute academic hospital. It will comprise risk communication using an online risk calculator, a counselling style adapted from motivational interviewing, and 12 weekly telephone goal reinforcement calls (3 months). Control subjects will receive verbal lifestyle advice only. Feasibility will be assessed through recruitment and retention. Qualitative evaluation interviews will be conducted with a subsample of 24 purposefully selected participants at 12 months. Assessment for risk factor changes will be measured at pre-intervention and 6 and 12 months. Associations between variables will also be assessed descriptively.DiscussionPreventive cardiology guidelines highlighted the importance of lifestyle interventions, and lifestyle intervention adherence was proven to reduce atherosclerotic cardiovascular disease (ASCVD) risk, regardless of the individual's genetic risk. Preventive cardiology programmes may fail to adequately support persons in modifying risky behaviours, and research demonstrates that healthy practices among high-risk individuals can remain suboptimal.Siblings and offspring of patients with premature CHD are at increased risk of ASCVD. Despite this, there is no process in place for routine screening and support to modify risk. It is hypothesised that participants assigned to the intervention arm will show more cardio-protective lifestyle-related improvement from the baseline than those in the control group. To date, this is the first trial being conducted amongst Maltese first-degree relatives. This study addresses the needed research, and the results will inform a definitive trial.The funding institution is the University of Malta.Trial registrationISRCTN, ISRCTN21559170; Registered 06/08/2020,

Implementation of a Machine-Learning Algorithm in the Electronic Health Record for Targeted Screening for Familial Hypercholesterolemia: A Quality Improvement Study.

Implementation of a Machine-Learning Algorithm in the Electronic Health Record for Targeted Screening for Familial Hypercholesterolemia: A Quality Improvement Study.

Abstract 16217: Culturally-tailored Team-based Preventive Cardiology Program Improves Cardiovascular Risk for South Asian Patients

Introduction: South Asians (SA) have a two times greater prevalence of CAD and metabolic syndrome (MetS) than matched Europeans. Diet and physical activity may be best addressed through culturally-tailored interventions. The Stanford South Asian Translational Heart Initiative (SSATHI) was designed to help SA better understand and improve their risk factors. We tested the hypothesis that a team-based and culturally-tailored clinical intervention for SA would result in a reduction in MetS risk factors. Methods: Patients underwent an initial assessment consisting of fasting lipid profile, advanced lipid studies (lipid fractionation, lp (a), apoA1, apoB), inflammatory markers (high sensitivity CRP, homocysteine), and A1c. All non-diabetics underwent two-hour OGTT. Following initial assessment by a cardiologist, a registered dietician developed a personalized nutrition plan based on SA cuisine. Results: A total of 395 patients were seen between July, 2011 and July, 2019. Of these, 198 (50%) completed at least two cardiologist visits with baseline and follow up labs. Patients had an average age of 45.5 years and 86% were male. At baseline, SSATHI patients had a mean BMI of 26.4 (IQR = 23.9-28.8), 52% of patients had total cholesterol greater than 190 mg/dl, 21% had systolic BP > 140 mmHg, and 13% had diastolic BP > 90 mmHg. During an average follow-up of 11.8 ± 9.2 months, diastolic BP declined from 80.9 ± 9.32 to 78.9 ± 7.6 mmHg (p = 0.028), total cholesterol decreased from 190.4 ± 46.4 to 153.4 ± 63.7 mg/dl (p < 0.001), total triglycerides declined from 137.1 ± 87.1 to 100.2 ± 67.5 mg/dl (p < 0.001), and LDL declined from 120.4 ± 40.0 to 92.3 ± 46.4 mg/dl (p <0.001). HDL declined from 49.0 ± 15.4 to 44.5 ± 19.8 mg/dl (p = 0.022). ASCVD and A1c were not significantly different. Conclusion: A team-based and culturally-informed program targeted to South Asian populations may help improve cardiometabolic risk factors but may be limited by program attrition and generalizability.

Lipid Profile Results after Cardiovascular Prevention Programme: Euroaction Model in Spain.

Cardiovascular prevention and rehabilitation programmes (CVPRP) are an established model of care designed to improve risk factor management. They have been successfully implemented in a variety of settings, in patients with coronary heart disease (CHD). To assess the long term impact of a nurse-coordinated, multidisciplinary, CVPRP in patients with CHD in the reduction of lipid profile and medication prescription in clinical practice. The study used an analytical, experimental, population based, prospective and longitudinal design. In Spain, the study was conducted in the Valencian Community, including two randomized hospitals. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out an 8-week CVPRP. The proportion of patients achieving improved standards of preventive care increased in the intervention hospital compared with the usual care hospital, mainly regarding LDL-C concentrations. Furthermore, an increased prescription of statins was found in the intervention group. However, there were no statistically significant differences in triglycerides and glucose levels. The EUROACTION nurse-led CVPRP enabled coronary patients to control lipid profile to the European targets. A large proportion of patients were prescribed statin therapy as cardioprotective medication with favorable changes in medication for coronary patients. To improve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to the health policy of individual countries.

ASPIRE-3-PREVENT: a cross-sectional survey of preventive care after a coronary event across the UK

ObjectiveTo quantify the implementation of the third Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3) after coronary event.MethodsUsing a cross-sectional survey design, patients were consecutively identified...

Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.

Abstract P337: CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians

Introduction: Exercise &amp; nutritional intervention programs are effective in lowering cardiovascular events in randomized control trials but success in real world settings may be limited by resource constraints. We describe the implementation &amp; preliminary effectiveness of a comprehensive telehealth lifestyle approach that provides culturally relevant lifestyle interventions, recognizing the role of acculturative stressors &amp; behavior patterns unique to South Asians. Methods: CardioClick was introduced in the Stanford South Asian Translational Heart Initiative on 11/1/2017 to deliver care via video visits. Patients ages 20-60 were offered enrollment. Those who did not consent were followed in the traditional in-person program. Both programs included a comprehensive risk assessment &amp; personalized treatment plan focused on aggressive risk reduction, with a set of 3 cardiologist &amp; 3 dietitian visits over 6 months. CardioClick patients received a lifestyle questionnaire &amp; satisfaction survey at each visit. Based on responses &amp; online dialog, culturally tailored nutrition, exercise recommendations &amp; resources to address sleep deficiencies &amp; perceived stress, were provided. Results: Out of 110 currently enrolled 23 have completed CardioClick. These patients were similar in age (44 vs 43 years) BMI (27.1 vs 26.7) &amp; cardiovascular risk (ASCVD 4.8 vs 4.5) but had more dietitian visits (3 vs 1), more likely to lose weight 83% (19/23) vs 54% (44/82) &amp; lost more weight (9lbs vs 0.7lbs) compared to traditional program patients. In the CardioClick group QDiabetes score (9.2 to 7.2) &amp; TG/HDL ratio (2.3 to 1.8) dropped. Questionnaire 100% (23/23) &amp; survey 57%(13/23) responses showed improved lifestyle behaviors &amp; patient satisfaction. Conclusion: Early results from a novel telemedicine preventive cardiology program showed improved patient engagement, lifestyle behaviors &amp; cardiometabolic benefits in high risk South Asians.

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.

The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. 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%. 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.

Drug photosensitivity today—Culprits, impact, and investigation

Young adults with familial hypercholesterolemia (FH) are at a critical period for establishing behaviors to promote future cardiovascular health.To examine challenges transitioning to adult care for young adults with FH and parents of FH-affected young adults in the context of 2 developmental tasks, transitioning from childhood to early adulthood and assuming responsibility for self-management of a chronic disorder.Semistructured, qualitative interviews were conducted with 12 young adults with FH and 12 parents of affected young adults from a pediatric subspecialty preventive cardiology program in a northeastern academic medical center. Analyses were conducted using a modified grounded theory framework.Respondents identified 5 challenges: (1) recognizing oneself as a decision maker, (2) navigating emerging independence, (3) prioritizing treatment for a chronic disorder with limited signs and symptoms, (4) managing social implications of FH, and (5) finding credible resources for guidance. Both young adults and parents proposed similar recommendations for addressing these challenges, including the need for family and peer involvement to establish and maintain diet and exercise routines and to provide medication reminders. Systems-level recommendations included early engagement of adolescents in shared decision-making with health care team; providing credible, educational resources regarding FH; and using blood tests to track treatment efficacy.Young adults with FH transitioning to adult care may benefit from explicit interventions to address challenges to establishing healthy lifestyle behaviors and medication adherence as they move toward being responsible for their medical care. Further research should explore the efficacy of recommended interventions.

Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey.

Aim The purpose of this study was to describe the proportions of patients referred to and attending cardiac rehabilitation programmes in Europe and to compare lifestyle and risk factor targets achieved according to participation in a cardiac rehabilitation programme. Methods The EUROASPIRE IV cross-sectional survey was undertaken in 78 centres from 24 European countries. Consecutive patients aged <80 years with acute coronary syndromes and/or revascularization procedures were interviewed at least six months after their event. Results A total of 7998 patients (24% females) were interviewed. Overall, 51% were advised to participate in a cardiac rehabilitation programme and 81% of them attended at least half of the sessions; being 41% of the study population. Older patients, women, those at low socio-economic status or enrolled with percutaneous coronary intervention and unstable angina, as well as those with a previous history of coronary disease, heart failure, hypertension or dysglycaemia were less likely to be advised to follow a cardiac rehabilitation programme. People smoking prior to the recruiting event were less likely to participate. The proportions of patients achieving lifestyle targets were higher in the cardiac rehabilitation programme group as compared to the non-cardiac rehabilitation programme group: stopping smoking (57% vs 47%, p < 0.0001), recommended physical activity levels (47% vs 38%, p < 0.0001) and body mass index<30 kg/m2 (65% vs 61%, p=0.0007). However, there were no differences in the blood pressure, lipids and glucose control. Patients who attended a cardiac rehabilitation programme had significantly lower anxiety and depression scores and better medication adherence. Conclusions Only half of all coronary patients were referred and a minority attended a cardiac rehabilitation programme. Those attending were more likely to achieve lifestyle targets, had lower depression and anxiety, and better medication adherence. There is still considerable potential to further reduce cardiovascular risk by increasing uptake and fully integrating secondary prevention and cardiac rehabilitation to provide a modern preventive cardiology programme.

The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention.

The Joint European Societies (JES) guidelines on cardiovascular disease (CVD) prevention published in 1994, 1998, 2003, 2007, 2012 and 2016 defined lifestyle and risk factors targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. Guideline implementation in Europe has been evaluated with four cross-sectional EUROASPIRE surveys starting in mid-1990s. The results showed poor lifestyle and risk factor management in patients with CHD and in high CVD risk people with high prevalences of smoking, obesity, central obesity and diabetes. The control of blood pressure, lipids and glucose was far from optimal. A comparison across the recent three surveys provided a unique description of time trends for secondary prevention over a period of 14 years. The results showed adverse lifestyle trends, a substantial increase in obesity, central obesity and diabetes. Despite significant improvement of blood pressure and lipid control many patients were not reaching the risk factor goals and there was no change in glucose control. Comparing the most recent two surveys, there were no major differences in lifestyle and risk factor management in people at high risk of developing CVD. A new approach to CVD prevention integrating primary and secondary prevention into a modern preventive cardiology programme, focusing on lifestyle and risk factor management is required, in order to reduce the risk of CVD events and improve quality of life in patients with CHD and those at high risk of developing CVD.

Transitioning from pediatric to adult health care with familial hypercholesterolemia: Listening to young adult and parent voices

Young adults with familial hypercholesterolemia (FH) are at a critical period for establishing behaviors to promote future cardiovascular health. To examine challenges transitioning to adult care for young adults with FH and parents of FH-affected young adults in the context of 2 developmental tasks, transitioning from childhood to early adulthood and assuming responsibility for self-management of a chronic disorder. Semistructured, qualitative interviews were conducted with 12 young adults with FH and 12 parents of affected young adults from a pediatric subspecialty preventive cardiology program in a northeastern academic medical center. Analyses were conducted using a modified grounded theory framework. Respondents identified 5 challenges: (1) recognizing oneself as a decision maker, (2) navigating emerging independence, (3) prioritizing treatment for a chronic disorder with limited signs and symptoms, (4) managing social implications of FH, and (5) finding credible resources for guidance. Both young adults and parents proposed similar recommendations for addressing these challenges, including the need for family and peer involvement to establish and maintain diet and exercise routines and to provide medication reminders. Systems-level recommendations included early engagement of adolescents in shared decision-making with health care team; providing credible, educational resources regarding FH; and using blood tests to track treatment efficacy. Young adults with FH transitioning to adult care may benefit from explicit interventions to address challenges to establishing healthy lifestyle behaviors and medication adherence as they move toward being responsible for their medical care. Further research should explore the efficacy of recommended interventions.

Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia

To determine the real-world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents. We analyzed data prospectively collected from a quality improvement initiative in the Boston Children's Hospital Preventive Cardiology Program. We included patients ≤21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (eg, diabetes, etc). Cox proportional hazards models were used to assess the impact of baseline clinical and lifestyle factors. Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years, 54% were female, and 24% obese, 62% with at least one lifestyle risk factor). The median baseline LDL-C was 215 (IQR 78) mg/dL, and median follow-up after starting statin was 1 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47-69). A lower probability of achieving LDL-C goals was associated with male sex (HR 0.5 [95% CI 0.3-0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87-0.98] per 10 mg/dL), but not age, body mass index percentile, lifestyle factors, or family history. The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Male patients and those with greater baseline LDL-C were less likely to be successful and may require increased support.

PT037 Health Economic Evaluation of a Preventive Cardiology Programme in Ireland

PT037 Health Economic Evaluation of a Preventive Cardiology Programme in Ireland

149 Lifestyle, Blood Pressure, Lipids and Diabetes Management in Patients with Coronary Heart Disease From 24 Countries in Europe

Introduction EUROASPIRE surveys, conducted by the European Society of Cardiology in 1995-96 (9 countries), 1999-2000 (15 countries) and 2006-2007 (22 countries) showed a high prevalence of modifiable risk factors in patients with coronary heart disease (CHD) in Europe and a real potential to further reduce morbidity and mortality. The aim of the EUROASPIRE IV survey was to determine in patients with CHD whether the Joint European Societies’ guidelines on cardiovascular disease (CVD) prevention are being followed in clinical practice. Methods EUROASPIRE IV survey was undertaken in 74 centres in 24 European countries. Consecutive patients, men and women Results A total of 16,426 medical records (24.4% females) were reviewed and 7,998 patients were interviewed on average 1.4 years following their index event. At interview, 16.0% of patients smoked cigarettes, 37.6% were obese (BMI ≥ 30 kg/m2), 52.7% had central obesity (waist circumference ≥ 102 cm in men or ≥ 88 cm in women), 58.2% had raised blood pressure (BP ≥ 140/90 mmHg; ≥ 140/80 mmHg for patients with diabetes), 80.5%% had LDL cholesterol ≥ 1.8 mmol/l and 26.8% had self-reported diabetes. The use of prophylactic drug therapies was as follows: aspirin or other anti-platelets drugs 93.8%, beta-blockers 82.6%, ACE inhibitors/ARBs 75.1%, and statins 85.7%. Only 53.3% of patients using blood pressure lowering medication were controlled (BP Conclusions EUROASPIRE IV shows that a large majority of coronary patients have adverse lifestyles and many do not achieve the blood pressure, lipid and diabetes targets. A wide gap continues to exist in the implementation of evidence-based medicine in cardiological practice in both hospital and primary care. There is a considerable potential to raise the standard of preventive care in Europe through preventive cardiology programmes involving multidisciplinary teams of health-care professionals helping patients to achieve the lifestyle, risk factors and therapeutic targets for CVD prevention.

Body fat and its relationship with clustering of cardiovascular risk factors.

Body mass index (BMI) and waist circumference (WC) are the most commonly measured anthropometric parameters given their association with cardiovascular risk factors (RFs). The relationship between percentage body fat (%BF) and cardiovascular risk has not been extensively studied. This study evaluated %BF and its relationship with cardiometabolic RFs in healthy subjects and compared these findings with the relationship between BMI/ WC and cardiovascular RFs. This was a cross-sectional study of 99 males and 83 females (mean age 38 ± 10 years) evaluated in a preventive cardiology program. All subjects completed a survey about RFs and lifestyle habits. Anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting lipid profile, and blood glucose were collected. Body fat was determined using four skinfold measurements. Fat mass index (FMI) was also calculated. Percentage body fat was significantly and directly associated with total cholesterol (R(2)=0.11), triglycerides (R(2)=0.14), low-density lipoprotein cholesterol (R(2)=0.16), non-high-density lipoprotein cholesterol (R(2)=0.24), fasting blood glucose (R(2)=0.16), SBP (R(2)=0.22), and DBP (R(2)=0.13) (p<0.001 for all) and inversely related to high-density lipoprotein cholesterol (R(2)=0.32; p<0.001). When the models of %BF, FMI, WC, and BMI were compared, all of them were significantly related to the same cardiometabolic RFs and the clustering of them. Percentage body fat and FMI were significantly associated with biochemical variables and to the clustering of RFs. However, these associations were similar but not better than WC and BMI.

EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.

To determine whether the Joint European Societies guidelines on cardiovascular prevention are being followed in everyday clinical practice of secondary prevention and to describe the lifestyle, risk factor and therapeutic management of coronary patients across Europe. EUROASPIRE IV was a cross-sectional study undertaken at 78 centres from 24 European countries. Patients <80 years with coronary disease who had coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome were identified from hospital records and interviewed and examined ≥ 6 months later. A total of 16,426 medical records were reviewed and 7998 patients (24.4% females) interviewed. At interview, 16.0% of patients smoked cigarettes, and 48.6% of those smoking at the time of the event were persistent smokers. Little or no physical activity was reported by 59.9%; 37.6% were obese (BMI ≥ 30 kg/m(2)) and 58.2% centrally obese (waist circumference ≥ 102 cm in men or ≥88 cm in women); 42.7% had blood pressure ≥ 140/90 mmHg (≥140/80 in people with diabetes); 80.5% had low-density lipoprotein cholesterol ≥ 1.8 mmol/l and 26.8% reported having diabetes. Cardioprotective medication was: anti-platelets 93.8%; beta-blockers 82.6%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75.1%; and statins 85.7%. Of the patients 50.7% were advised to participate in a cardiac rehabilitation programme and 81.3% of those advised attended at least one-half of the sessions. A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes. Risk factor control is inadequate despite high reported use of medications and there are large variations in secondary prevention practice between centres. Less than one-half of the coronary patients access cardiac prevention and rehabilitation programmes. All coronary and vascular patients require a modern preventive cardiology programme, appropriately adapted to medical and cultural settings in each country, to achieve healthier lifestyles, better risk factor control and adherence with cardioprotective medications.