Cholesterol, blood pressure, diabetes and kidney health: why the risk of heart problems remains after a heart attack

Six out of ten people do not achieve the much-coveted blood pressure reading of 130/80 millimetres of mercury. 83 per cent of patients have LDL cholesterol – the ‘bad’ sort, which is a major cause of heart attacks and contributes to plaque rupture – at levels above 55 milligrams per decilitre. One in three people are struggling to manage their diabetes effectively, and 31 per cent of patients also have to cope with chronic kidney disease. In short, if we take the recommendations of the European Society of Cardiology (ESC) guidelines as our starting point, there is certainly little to smile about for those who have had a heart attack, undergone coronary revascularisation procedures or are still suffering from unstable angina.
This has been highlighted once again by the recently published results of the Euroaspire VI study, conducted across 27 countries – including the major European nations and Italia, which participated through a number of centres. The research, presented at the ESC Congress in Munich, had a very specific objective: to compare diagnostic and therapeutic strategies in patients with ischaemic heart disease in order to assess whether the ESC guidelines are actually being followed after discharge from hospital. ‘Unfortunately, the results are not as satisfactory as one might hope,’ comments Furio Colivicchi, president of the ANMCO Foundation for Your Heart and national lead for the Euroaspire VI study. “Despite the availability of effective and safe medicines capable of controlling various risk factors – and which have been shown to reduce the risk of disease progression and new events – their use in clinical practice is clearly insufficient.”

In short, it is a long way from theory to practice. “The finding that risk factors are not being adequately managed and that adherence to a healthy lifestyle is sub-optimal, as reported in the Euroaspire VI study, highlights the urgent need to invest in prevention and rehabilitation following an acute event, but it also highlights that there is still a long way to go, even if the treatment strategies to achieve the goal might well exist,” says the expert. The case of LDL cholesterol is paradigmatic here. More than four in five patients fail to reach the target, but if you look at the figures, you can see that 93 per cent of participants are on medication that should enable them to reach the target. ‘As there are various medicines available, this could mean that they are not being used optimally,’ notes Colivicchi. ‘But as mentioned, this is just one example. In fact, if you look at the uptake of all the medicines to be prescribed according to the guidelines, 34 per cent of people are following their treatment regularly.” Just over one in three patients, in short. And that really is very few.

It should be noted that Euroaspire considers not only any medication taken by the patient as part of its objectives, but also examines lifestyle factors (smoking, weight, diet, etc.) that can have a significant impact on the cardiovascular system, particularly following an acute event. In the rankings, Italia is in fourth place, with 24 per cent of people meeting the targets set out in the guidelines, based on a holistic assessment of the patient’s characteristics. We are not doing too badly, considering that Germany, at the top of the rankings, stands at 29 per cent and that Sweden and France, on the podium, are only slightly ahead of us. But there is one aspect that absolutely must be improved. In Italia, just over one in two people (53 per cent) undergo a targeted rehabilitation programme following a heart attack. In this respect, we are in the middle of the rankings compared with the other 27 countries involved in the study. And that is certainly not good enough. The results of this study must therefore serve as a strong incentive to improve care following a heart attack. ‘The tools are there; they just need to be put into practice more effectively,’ concludes Colivicchi. There is room for improvement – and plenty of it – in the area of rehabilitation too, especially given that the first European guidelines on rehabilitation have just been published, emphasising the importance of participating in cardiac rehabilitation programmes’.