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

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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 6months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1year 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 75bpm (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, GLUCOSE-TOLERANCE TEST, PERIPHERAL ARTERIAL-DISEASE, RISK-FACTOR, MYOCARDIAL-INFARCTION, EUROPEAN GUIDELINES, CLINICAL-PRACTICE, MORTALITY, OUTCOMES, ASSOCIATION, PREVENTION

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MLA
De Bacquer, Dirk, et al. “Incidence of Cardiovascular Events in Patients with Stabilized Coronary Heart Disease : The EUROASPIRE IV Follow-up Study.” EUROPEAN JOURNAL OF EPIDEMIOLOGY, vol. 34, no. 3, 2019, pp. 247–58.
APA
De Bacquer, D., De Smedt, D., Kotseva, K., Jennings, C., Wood, D., Rydén, L., … De Backer, G. (2019). Incidence of cardiovascular events in patients with stabilized coronary heart disease : the EUROASPIRE IV follow-up study. EUROPEAN JOURNAL OF EPIDEMIOLOGY, 34(3), 247–258.
Chicago author-date
De Bacquer, Dirk, Delphine De Smedt, Kornelia Kotseva, Catriona Jennings, David Wood, Lars Rydén, Viveca Gyberg, et al. 2019. “Incidence of Cardiovascular Events in Patients with Stabilized Coronary Heart Disease : The EUROASPIRE IV Follow-up Study.” EUROPEAN JOURNAL OF EPIDEMIOLOGY 34 (3): 247–58.
Chicago author-date (all authors)
De Bacquer, Dirk, 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, and Gui De Backer. 2019. “Incidence of Cardiovascular Events in Patients with Stabilized Coronary Heart Disease : The EUROASPIRE IV Follow-up Study.” EUROPEAN JOURNAL OF EPIDEMIOLOGY 34 (3): 247–258.
Vancouver
1.
De Bacquer D, De Smedt D, Kotseva K, Jennings C, Wood D, Rydén L, et al. Incidence of cardiovascular events in patients with stabilized coronary heart disease : the EUROASPIRE IV follow-up study. EUROPEAN JOURNAL OF EPIDEMIOLOGY. 2019;34(3):247–58.
IEEE
[1]
D. De Bacquer et al., “Incidence of cardiovascular events in patients with stabilized coronary heart disease : the EUROASPIRE IV follow-up study,” EUROPEAN JOURNAL OF EPIDEMIOLOGY, vol. 34, no. 3, pp. 247–258, 2019.
@article{8628960,
  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 6months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1year 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 75bpm (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.},
  author       = {De Bacquer, Dirk and De Smedt, Delphine and Kotseva, Kornelia and Jennings, Catriona and Wood, David and Rydén, Lars and Gyberg, Viveca and Shahim, Bahira and Amouyel, Philippe and Bruthans, Jan and Castro Conde, Almudena and Cífková, Renata and Deckers, Jaap W and De Sutter, Johan and Dilic, Mirza and Dolzhenko, Maryna and Erglis, Andrejs and Fras, Zlatko and Gaita, Dan and Gotcheva, Nina and Goudevenos, John and Heuschmann, Peter and Laucevicius, Aleksandras and Lehto, Seppo and Lovic, Dragan and Miličić, Davor and Moore, David and Nicolaides, Evagoras and Oganov, Raphael and Pajak, Andrzej and Pogosova, Nana and Reiner, Zeljko and Stagmo, Martin and Störk, Stefan and Tokgözoğlu, Lale and Vulic, Dusko and Wagner, Martin and De Backer, Gui},
  issn         = {0393-2990},
  journal      = {EUROPEAN JOURNAL OF EPIDEMIOLOGY},
  keywords     = {Coronary heart disease,Guidelines implementation,Secondary prevention,GLUCOSE-TOLERANCE TEST,PERIPHERAL ARTERIAL-DISEASE,RISK-FACTOR,MYOCARDIAL-INFARCTION,EUROPEAN GUIDELINES,CLINICAL-PRACTICE,MORTALITY,OUTCOMES,ASSOCIATION,PREVENTION},
  language     = {eng},
  number       = {3},
  pages        = {247--258},
  title        = {Incidence of cardiovascular events in patients with stabilized coronary heart disease : the EUROASPIRE IV follow-up study},
  url          = {http://dx.doi.org/10.1007/s10654-018-0454-0},
  volume       = {34},
  year         = {2019},
}

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