Objective To ascertain in which way conventional risk factors, readiness to modify behaviour and to comply with recommended medication, and the effect of this medication were associated with education in patients with established coronary heart disease (CHD).
Methods The EUROASPIRE IV (EUROpean Action on Secondary Prevention byIntervention to Reduce Events) study was a cross-sectional survey undertaken in 24European countries to ascertain how recommendations on secondary CHD prevention are being followed in clinical practice. Consecutive patients, men and women <80 years of age who had been hospitalized for an acute coronary syndrome or revascularization procedures, were identified retrospectively. Data were collected through an interview with examinations at least six months after hospitalization.Results A total of 7937 patients (1934 women) were evaluated. Patients with primary education were older, with a larger proportion of women. The control of risk factors, as defined by JES 4 and JES 5 guidelines, was significantly better with higher education for current smoking (p=0.001), overweight and obesity (p=0.047 and p=0.029 respectively), low physical activity (p<0.001) and low HDL-cholesterol (p=0.011) in men, and for obesity (p=0.005), high blood pressure (p<001), low physical activity (p=0.001), diabetes (p<0.001) and low HDL-cholesterol (p=0.023) in women. Taking high education as reference, a significantly higher risk was observed in men for overweight, smoking, low HDL and low physical activity, and in women for overweight, obesity, diabetes, high blood pressure, low HDL and low physical activity.Patiens with primary and secondary education were more often treated with diuretic and antidiabetic drugs, other significant differences in drug use were not found.
Conclusions: Particular risk communication and control are needed in secondaryCHD prevention for patients with lower educational status.Keywords: educational level and CHD risk factors, educational level and risk factors control, coronary heart disease, secondary prevention, EUROASPIRE IV study Summary: Our study, performed in 2012-2013, found the differences in cardiovascular risk factors prevalence and control according to educational level, most pronounced in women and in risk factors obesity and diabetes. Compared to previous studies, the differences in cardiovascular risk factors prevalence and control according to educational level remained relatively stable. This study indicates the need to pay special attention to coronary patients with low education, possibly with obesity and diabetes control as a major target.