Sekundärprävention der koronaren Herzkrankheit

Hintergrund: EuroASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) ist eine europäische Verbundstudie mit dem Ziel, die klinische Praxis der koronaren Sekundärprävention vor dem Hintergrund der europäischen Empfehlungen zur koronaren Prävention zu evaluieren. In einer Querschnittsstudie wurden 1995/96 3569 Patienten aus neun Ländern untersucht (EuroASPIRE I). Eine zweite Querschnittsstudie wurde 1999/2000 an 5556 Patienten aus 15 Ländern durchgeführt (EuroASPIRE II), um u. a. Veränderungen in der koronaren Prävention gegenüber der ersten Studie zu untersuchen.

Methoden: Der deutsche Teil von EuroASPIRE I und II wurde in der Region Münster durchgeführt. An den beiden Studien beteiligten sich 392 bzw. 402 Frauen und Männer im Alter bis zu 70 Jahren mit gesicherter Diagnose einer koronaren Herzkrankheit (KHK). Informationen zu Lebensstil, Risikofaktoren und medikamentöser Therapie wurden retrospektiv aus Krankenakten und durch eine standardisierte Nachuntersuchung und Befragung gewonnen.

Ergebnisse: Die Prävalenz kardiovaskulärer Risikofaktoren war in beiden Studien hoch. Über 60% der Patienten wiesen zwei oder mehr Risikofaktoren zum Zeitpunkt der Nachuntersuchung auf. Der Vergleich beider Studien zeigt eine substanzielle Abnahme der Hypercholesterinämie um 20%, die Häufigkeit von Hypertonie und Adipositas nahm hingegen zu. Der Einsatz von ACE-Hemmern, Betablockern und Lipidsenkern, insbesondere Statinen, war in der zweiten Studie signifikant höher.

Schlussfolgerungen: EuroASPIRE I und II in der Region Münster zeigen wie in allen beteiligten europäischen Studienregionen eine unzureichende Sekundärprävention der KHK, die sich in dem Zeitraum 1996-2000 nicht wesentlich verbessert hat. Mögliche Ursachen und Ansatzpunkte zur Verbesserung werden diskutiert.

Secondary prevention of coronary heart disease. Results from EuroASPIRE I and II in the region of Münster, Germany

Background: EuroASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) is a European multicenter study on secondary prevention in patients with coronary heart disease (CHD). The first cross-sectional survey was undertaken in 1995/96 among 3569 patients from nine countries. A second cross-sectional survey (EuroASPIRE II) was conducted in 1999/2000 among 5556 patients from 15 countries to evaluate among others whether coronary prevention had improved since the first.

Methods: The present study was conducted in the region of Münster, Germany, as part of the EuroASPIRE study. Consecutive patients, men and women up to 70 years of age with established CHD, were identified retrospectively. A total of 392 (EuroASPIRE I) and 402 (EuroASPIRE II) patients participated. Information on cardiovascular risk factors, lifestyle and medication were obtained through medical records, interviews and examinations.

Results: Both studies demonstrate a high prevalence of risk factors among CHD patients. At the time of the interview more than 60% of the patients in both surveys had two or more risk factors. The comparison of EuroASPIRE I and II reveals a substantial decrease of 20% in the prevalence of hypercholesterolemia, but an increase in the prevalence of hypertension and obesity. ACE-inhibitors, betablockers and lipid lowering drugs, especially statins, were used more frequently in EuroASPIRE II.

Conclusions: We conclude that secondary prevention of CHD in the region of Münster like in the other European study regions is less than optimal and has not substantially improved between 1996 and 2000. Potential reasons are discussed.

1 Die Studie wurde gefördert von der European Society of Cardiology, Sophia Antipolis, Frankreich, der Fa. Pfizer, Karlsruhe und der Fa. AstraZeneca, Wedel/Holstein.

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1 Die Studie wurde gefördert von der European Society of Cardiology, Sophia Antipolis, Frankreich, der Fa. Pfizer, Karlsruhe und der Fa. AstraZeneca, Wedel/Holstein.

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