Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015–16

Abstract

Aims To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway. Methods and results In the population-based Tromsø Study 2015–16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (<140/90 mmHg, <130/80 mmHg if diabetes), LDL cholesterol (<1.8 mmol/L), HbA1c (<7.0% if diabetes), overweight (body mass index (BMI) <25 kg/m2, waist circumference women <80 cm, men <94 cm), smoking (non-smoking), physical activity (self-reported >sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat <10E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers. Conclusion Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care and treatment after MI and stroke is needed.

Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol

“…In Tromsø 7, blood pressure was measured by trained personnel using a digital automated device (Dinamap ProCare 300 monitor, GE Healthcare, Norway). Three measurements were taken with 1-minute intervals and after 2 minutes of seated rest [12]. In the analyses, we used the mean of the two final measurements, except if the third measurement was missing (n = 2), then we only used the second measurement.…”

“…LDL-cholesterol was collected and analysed by trained personnel using enzymatic colorimetric methods with commercial kits on a Cobas 8000 c702 (Roche Diagnostics GmbH, Mannheim, Germany) from non-fasting venous blood samples. The analysis was performed at the Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway (ISO certification NS-EN ISO 15189:2012) [12]. Eleven participants did not have any LDL-cholesterol measurements registered and were excluded from the analysis of LDL-cholesterol.…”

“…In the more recent guidelines concerning management of chronic coronary syndromes and those concerning hypercholesterolemia, the recommendations for persons with a very high risk of new coronary events are now further reduced to an LDL-cholesterol reduction of ≥ 50% from baseline and an LDL-cholesterol goal of < 1.4 mmol/L (< 55 mg/dL) [9,10]. Risk factor control among persons with CHD is found to be suboptimal, also in population-based studies [11][12][13][14]. Treatment goal achievement for LDL-cholesterol is particularly low.…”

Joint Exposure to Ambient Air Pollutants, Genetic Risk, and Ischemic Stroke: A Prospective Analysis in UK Biobank

“…Moreover, some other factors such as the habitation change and life habit may introduce bias. 38,39 In the current study, we comprehensively assess the association between the incidence of IS and various Adjusted for age, sex, UK Biobank assessment center, alcohol score, healthy diet score, body mass index, physical activity, glucose, diastolic blood pressure, systolic blood pressure, total household income, smoking status, qualifications education. HR indicates hazard ratio; NO 2 , nitrogen dioxide; NO x , nitrogen oxide; PM 2.5 , particulate matter with diameters ≤2.5 micrometers; PM 2.5-10 , particulate matter with diameters between 2.5 and 10 micrometers; and PM 10 , particulate matter with diameter ≤10 micrometers.…”

“…Moreover, some other factors such as the habitation change and life habit may introduce bias. 38,39 In the current study, we comprehensively assess the association between the incidence of IS and various air pollutants, including PM 2.5 , PM 2.5− 10 , PM 10 , NO 2 , and NO x . In addition, a wide range of covariates were taken into consideration, and several sensitivity analyses were conducted in this study.…”