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Risk factor control in secondary prevention of cardiovascular disease: results from the multi-ethnic HELIUS study
M Minneboo1, S Lachman2, M B Snijder3
1Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. m.minneboo@amc.uva.nl.
Insights
Secondary cardiovascular disease (CVD) prevention shows significant gaps, with only 2% of patients meeting all risk factor targets. Ethnic disparities exist, but broad strategies are needed before tailoring interventions to specific ethnic groups.
Area of Science:
- Cardiovascular disease research
- Public health
- Health inequalities
Background:
- Secondary prevention of cardiovascular disease (CVD) is crucial for managing patient outcomes.
- Contemporary guidelines exist from the European Society of Cardiology for managing CVD risk factors.
- Ethnic variations in health and healthcare access may impact CVD prevention strategies.
Purpose of the Study:
- To assess the effectiveness of current secondary CVD prevention strategies.
- To identify and analyze differences in CVD risk factor management across six ethnic groups.
- To evaluate adherence to preventive treatment goals in a diverse urban population.
Main Methods:
- Utilized data from the HEalthy LIfe in an Urban Setting (HELIUS) study in Amsterdam.
- Included participants with a self-reported history of CVD.
- Quantified patient adherence to treatment goals for hypertension, dyslipidaemia, smoking, overweight, physical inactivity, and diabetes mellitus.
Main Results:
- Only 2% of 1163 CVD patients met all six preventive risk factor targets.
- Significant proportions of patients were not at goal: 31% for blood pressure, 58% for LDL cholesterol, 33% for non-smoking, 76% for healthy BMI, and 46% for physical activity.
- Ethnic minorities, particularly Ghanaian and Moroccan groups, showed higher smoking rates but lower healthy BMI and physical activity levels compared to the Dutch group.
Conclusions:
- Substantial gaps exist in the secondary prevention of CVD, indicating a need for improved management strategies.
- While ethnic differences in risk factors are present, a universal approach to risk factor management should be prioritized.
- Future interventions should focus on broad improvements before implementing ethnically specific strategies.
Objective:
To evaluate the quality of contemporary secondary prevention of cardiovascular disease (CVD), and the differences between six ethnic groups in a large, observational cohort.
Design:
We included participants with a self-reported history of CVD from the HEalthy LIfe in an Urban Setting (HELIUS) study, which investigates inequalities in health between six ethnic groups living in Amsterdam, the Netherlands. We quantified the proportions of patients who were at the preventive treatment goal according to the guidelines of the European Society of Cardiology for six risk factors: hypertension, dyslipidaemia, smoking, overweight, physical inactivity and diabetes mellitus, and the use preventive medication.
Results:
Of 22,165 participants, 1163 (5%) reported a history of CVD. Mean age was 54 years. Overall, 69% had a systolic blood pressure of <140 mm Hg, and 42% had a low-density lipoprotein (LDL) cholesterol of <2.5 mmol/l. Non-smoking was found in 67%. Body mass index (BMI) <25 kg/m2 was found in 24%, and 54% reported adequate physical activity. The mean number of risk factors per patient was three (±1.1) out of six, and only 2% had all risk factors on target. Across the ethnic groups, non-smoking was more prevalent in the Ghanaian and Moroccan groups than in the Dutch (p < 0.001 and p = 0.001, respectively); BMI <25 kg/m2 and adequate physical activity were less prevalent among all ethnic minority groups compared with the Dutch group.
Conclusion:
We found large treatment gaps in secondary prevention of CVD. Ethnic differences in risk factors were found; however, strategies to improve overall risk factor management may be mandated before designing ethnic-specific strategies.