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Background: We sought to determine whether the risks and benefits of prolonging dual-antiplatelet therapy (DAPT) beyond 1 year after drug-eluting stent implantation depend on clinical presentation in a meta-analysis of randomized controlled trials. Methods and Results: Randomized controlled trials comparing ≤1- versus >1-year DAPT after drug-eluting stent placement were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary efficacy end point was myocardial infarction, whereas the primary safety end point was major bleeding. Net clinical benefit was defined as the composite of myocardial infarction or major bleeding. Outcomes were analyzed according to patient presentation with stable ischemic heart disease versus acute coronary syndromes. The meta-analysis included 6 trials with a total of 21 457 patients, including 14 132 with stable ischemic heart disease and 7325 with acute coronary syndrome. After a median follow-up of 19.5 months, ≤1-year DAPT was associated with higher rates of myocardial infarction compared with >1-year DAPT (hazard ratio [HR], 1.63; 95% CI, 1.37–1.95), with no interaction apparent between treatment effect and clinical presentation. Shorter DAPT was associated with reduced rates of major bleeding compared with longer DAPT (HR, 0.64; 95% CI, 0.42–0.99) with no significant interaction between treatment effect and clinical presentation. However, a net clinical benefit of >1-year DAPT was present in patients with acute coronary syndrome (HR of shorter versus longer DAPT, 1.59; 95% CI, 1.24–2.02) but not in those with stable ischemic heart disease (HR, 1.15; 95% CI, 0.89–1.51; P interaction =0.04). Shorter DAPT was also associated with lower rates of noncardiac mortality compared with longer DAPT (HR, 0.71; 95% CI, 0.52–0.96), with no significant interaction between treatment effect and clinical presentation ( P interaction =0.12). Conclusions: Compared with ≤1-year DAPT, >1-year DAPT reduces the risk of myocardial infarction but increases the risk of major bleeding and noncardiac mortality. A net clinical benefit of extended DAPT was apparent for patients with acute coronary syndrome but not for those with stable ischemic heart disease.

OBJECTIVE: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. METHODS: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥50years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥2 additional major cardiovascular risk factors). RESULTS: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol

AIMS: Most studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk. METHODS AND RESULTS: This study was conducted with 7641 outpatients aged ≥50 years, free of clinical CVD and with at least one major CVD risk factor, selected from 12 European countries in 2009. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Cholesterol fractions and glycated haemoglobin (HbA1c) were measured in a central laboratory. Cardiovascular disease risk was estimated with the SCORE equation. Patients' mean age was 63 years (48% men), and 40.1% had a high CVD risk. Among treated hypertensives (94.2%), only 38.8% achieved the blood pressure target of

Purpose: Cardiovascular disease (CVD) imposes a significant health burden throughout Europe. Cardiovascular risk can be assessed using validated risk prediction models, such as the European Systematic COronary Risk Evaluation (SCORE) algorithm that assesses 10-year risk of cardiovascular mortality. This is also recommended for guiding treatment options. Recently, the SCORE algorithm has been updated to incorporate high-density lipoprotein cholesterol (HDL-C) levels (SCORE-HDL), thus providing a more accurate estimate of risk. We have investigated the proportion of patients who would have their risk classification changed with the SCORE-HDL algorithm when compared to the original SCORE. Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, diabetes mellitus, smoking or obesity). We calculated risk using international SCORE and SCORE-HDL algorithms in patients aged 50–65 years without diabetes and not receiving lipid-lowering therapy. Results: In total, risk was assessed in 2321 patients. According to SCORE, 447 were at low risk (LR), 1409 were at intermediate risk (IR) and 465 were at high risk (HR) of CVD mortality (LR: < 1%; IR: 1–5%; HR ≥ 5% 10-year risk). According to SCORE-HDL, 597 were at LR, 1328 were at IR and 396 were at HR. Of the 447 patients at LR according to SCORE, 11.9% were reclassified by SCORE-HDL as IR and none as HR. Of the 1409 patients at IR according to SCORE, 14.3% and 2.9% were reclassified as LR and HR, respectively. Of the 465 patients at HR according to SCORE, 23.4% and 0.2% were reclassified as IR and LR, respectively. Comparable proportions of males and females at IR according to SCORE were reclassified as HR by SCORE-HDL (3.6 and 2.4%, respectively). However, only 1.9% of males were reclassified from IR to LR, in contrast to 24.9% of females. Conclusions: Assessment of CVD risk using SCORE-HDL in our patient population (aged 50–65 years, with at least one cardiovascular risk factor but no history of CVD, without diabetes and not receiving lipid-lowering therapy) often resulted in cardiovascular risk reclassification when compared with the original SCORE. Reclassification into a lower risk category was more common than into a higher risk category, especially amongst females at IR according to SCORE. Most of our study cohort were categorized as LR or IR by both algorithms.

Purpose: Current European guidelines recommend that patients free from cardiovascular disease (CVD) but estimated to be at high (≥ 5%) 10-year risk of CVD mortality should be more vigorously pharmacologically treated than those at lower risk. The recommended target level of low-density lipoprotein cholesterol (LDL-C) is < 2.5 mmol/l, or < 1.8 mmol/l for those at very high risk (VHR; those with diabetes mellitus [DM] or a ≥ 10% 10-year mortality risk). We examined the use of lipid lowering therapy (LLT) and achievement of LDL-C level targets in routine clinical practice in Europe. Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries from May 2009 to January 2010, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, DM, smoking or obesity). Ten-year CVD mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE) algorithm. LDL-C levels were measured and use of LLT was noted, including the agents and doses used. Statin therapy was classified as low-intensity (LIS; pravastatin, simvastatin, lovastatin, fluvastatin, atorvastatin < 40 mg or rosuvastatin < 20 mg) or high-intensity (HIS; atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg). Results: We identified 3278 individuals who were receiving any form of LLT, of whom 3040 (92.7%) were receiving a statin. Of the 4363 patients not receiving LLT, 1741 (39.9%) had DM or a SCORE risk ≥ 5%. LDL-C levels were available for 3151 participants receiving LLT, for whom LDL-C levels were not at target (< 2.5 mmol/l) in 1931 (61.3%). Only 8.9% of patients on LLT were receiving HIS. Of the patients receiving LIS, only 39.8% had LDL-C levels < 2.5 mmol/l. A subset of 2970 patients were at VHR, of whom only 1469 (49.5%) were receiving any form of LLT. LDL-C levels were at target (< 1.8 mmol/l) in 17.1% of these patients. Only 9.1% of the VHR patients on LLT were receiving HIS. Of the VHR patients receiving LIS, only 17.1% had Conclusion: Approximately 40% of patients aged ≥ 50 years with at least 1 cardiovascular risk factor who are not currently receiving LLT are at high risk of CVD (DM or SCORE ≥ 5%). Furthermore, well over half of all those receiving LLT and more than 80% of VHR patients receiving LLT did not achieve recommended LDL-C levels. These results demonstrate that there is potential for major improvements in lipid level management in patients at risk of CVD in Europe.

Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe. Methods Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account. Results The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27). Conclusions Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study., The EURIKA study was funded by AstraZeneca. The study was run by an independent academic steering committee