Nearly two-thirds of people at high risk of heart disease and stroke have excess belly fat, according to results of the European Society of Cardiology (ESC) EUROASPIRE V survey presented today at the World Congress of Cardiology & Cardiovascular Health in Dubai, United Arab Emirates.¹

Excess fat around the middle of the body (central obesity) is a marker of abnormal fat distribution. This belly fat is bad for the heart, even in people who are not otherwise overweight or obese.

Cardiovascular diseases are the leading cause of death in Europe. Each year in Europe there are more than 11 million new cases of cardiovascular disease and 3.9 million deaths caused by cardiovascular disease.² Elimination of risk behaviours would prevent at least 80% of cardiovascular diseases.³

The study also found that less than half (47%) of those on antihypertensive medication reached the blood pressure target of less than 140/90 mmHg (less than 140/85 mmHg in patients with self-reported diabetes). Among those taking lipid-lowering drugs, only 43% attained the LDL cholesterol target of less than 2.5 mmol/L. In addition, many participants not taking any antihypertensive and/or lipid-lowering therapy had elevated blood pressure and elevated LDL cholesterol. Among patients being treated for type 2 diabetes, 65% achieved the blood sugar target of glycated haemoglobin (HbA1c) less than < 7.0%.

Professor Kornelia Kotseva, chair of the EUROASPIRE Steering Committee from Imperial College London, UK, said: “The survey shows that large proportions of individuals at high risk of cardiovascular disease have unhealthy lifestyle habits and uncontrolled blood pressure, lipids and diabetes.”

EUROASPIRE is a series of cross sectional surveys on the prevention of cardiovascular disease in ESC member countries.⁴ The results of the primary care arm of EUROASPIRE V are reported today. The study was conducted in 2017 to 2018 in 78 general practices in 16 primarily European countries.⁵

Each general practice enrolled consecutive individuals under the age of 80 years with no history of coronary artery disease or other atherosclerotic disease, but who were at high risk of developing cardiovascular disease. High risk was defined as having high blood pressure, high cholesterol, and/or diabetes; the study therefore recruited individuals who had been prescribed antihypertensive, lipid-lowering, and/or anti-diabetes treatments (diet and/or oral hypoglycaemics and/or insulin).

Participants were retrospectively identified using medical records and invited to an interview and clinical examination. Questions were asked about smoking, diet, physical activity, blood pressure, lipids and diabetes. Measurements included height, weight, waist circumference, blood pressure, low-density lipoprotein (LDL) cholesterol levels, and blood sugar levels. The primary outcomes were the proportions of participants achieving targets for cardiovascular disease prevention in the 2016 European guidelines.3

A total of 2,759 participants were interviewed and examined using standardised methods and instruments. Nearly two-thirds (64%) were centrally obese (waist circumference 88 cm or greater for women and 102 cm or higher for men). Some 37% were overweight (body mass index [BMI] 25 to 29.9 kg/m²) and 44% were obese (BMI 30 kg/m² or above). Nearly one in five participants (18%) were smokers and just 36% achieved the recommended physical activity level of at least 30 minutes, five times per week.

Professor Kotseva said: “GPs should proactively look for cardiovascular risk factors so that comprehensive treatment and advice can be given. She added: “GPs need to go beyond treating the risk factors they know about, and always investigate smoking, obesity, unhealthy diet, physical inactivity, blood pressure, cholesterol, and diabetes. People are often unaware that they need treatment—for example they visit their GP for their diabetes but do not know they also have high blood pressure. In our study, many participants with high blood pressure and cholesterol were not being treated.”

She continued: “These data make it clear that more efforts must be made to improve cardiovascular prevention in people at high risk of cardiovascular disease. Our analysis highlights the need for health care systems to invest in prevention.”

“Public health initiatives will also help to prevent heart disease and stroke,” Professor Kotseva highlighted. “This includes smoking bans, taxing foods high in sugar and saturated fat, and providing areas for exercise.”

References and notes:

1. The EUROASPIRE V results will be presented on Friday 7 December, 15:00 to 16:00 Dubai time, during the session ‘EORP Registries: EUROASPIRE V Study on CVD Prevention and Diabetes - principal results in patients at high CVD risk in primary care’.

2. European cardiovascular disease statistics 2017.

3. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. 2016;37:2315–2381.

4. About EUROASPIRE: EUROASPIRE (EUROpean Action on Secondary and Primary Prevention In order to Reduce Events) is a series of cross sectional surveys of the practice of preventive cardiology in patients with coronary heart disease and people at high risk of developing cardiovascular disease across Europe. Five EUROASPIRE surveys have been conducted under the auspices of the European Society of Cardiology’s Euro Heart Survey and EURObservational Research Programme.

5. The participating countries were: Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Egypt, Greece, Kazakhstan, Kyrgyzstan, Lithuania, Poland, Portugal, Romania, Russia, Sweden, Ukraine, and the UK.