EUROASPIRE IV:Where do we stand after EUROASPIRE I, II and III?

Kornelia Kotsevaon behalf of the EUROASPIRE Investigators

National Heart and Lung Institute

Imperial College London

Declaration of interest: Research contracts

European guidelines and surveys oncardiovascular disease prevention

1994 First Joint Task Force Recommendations

1994 Joint European Societies Implementation Group

on Coronary Prevention

1995-96 EUROASPIRE I

1998 Second Joint Task Force Recommendations

1999-2000 EUROASPIRE II

2000 Joint European Societies CVD Prevention Committe

2003 Third Joint Task Force Recommendations

Joint European Societies CVD Prevention Committe

2006-2007-06 EUROASPIRE III

2007 Fourth Joint Task Force Recommendations

2012 Fifth Joint Task Force Recommendations

2012 -13 EUROASPIRE IV - EUROPEAN SURVEY OF CVD PREVENTION AND DIABETES

Euroaspire IVParticipating countries

Finland

Czech RepublicFrance

Germany

Netherlands

SloveniaSpain

Belgium

Ireland

UK

Greece

Poland

Latvia

Lithuania

Romania

Russia

Croatia

Bulgaria

Cyprus

Turkey

Serbia Bosnia

Herzegovina

Ukraine

Sweden

Euroaspire IVThe essential components

Identifies risk factors in coronary patients

Describes their management through life style

advice and the use of drug therapy

Presents an objective assessment of the clinical

implementation of current evidence based knowledge

The survey

Euroaspire IV

Study population

Consecutive patients, men and women < 80 yrs,hospitalised at least 6 months and at most 3 years priorto the interview1. Elective or emergency CABG

2. Elective or emergency PCI

3. Acute Myocardial Infarction (AMI) (ST-elevation or non-ST elevation MI)

4. Acute Myocardial Ischaemia (Ischaemia) but NO evidence of AMI (Troponin negative)

Euroaspire IV

Outcome measures

Proportions of coronary patients achieving the European lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention defined in the Joint European Societies Guidelines on CVD prevention

Euroaspire IV

Data collection

Trained research assistants

Retrospective identification of patients (not less

than 6 months and not more than 3 years prior

to the expected date of interview)

Review of medical notes

Interview and examination

Euroaspire IV

Recorded in all patients

Height, weight (SECA height measure & weighing scales)

Waist circumference (Metal tape measures)

Blood pressure (Omron M6)

Breath CO (Bedfont Micro+)

Fasting venous blood sample for serum total cholesterol, HDL-

cholesterol, triglycerides, HbA1c and creatinine

HbA1c, Fasting glucose, OGTT (HemoCue®)

Urine albumin/ creatinine ratio

EUROASPIRE IV

• 24 countries

• 76 centres

• 13,586 patients with CHD

• 7998 interviews

Lifestyle

• No smoking

• Healthy food choices

• Physical activity: 30 min of moderate activity a day

• BMI <25 kg/m2 and avoidance of central obesity

Speaker

8%

8%

10%

11%

12%

12%

12%

14%

14%

16%

16%

17%

17%

18%

18%

18%

18%

19%

20%

20%

23%

25%

26%

28%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Finland Belgium Slovenia

Romania Spain

Germany

Latvia

Sweden

Ukraine

United Kingdom Netherlands

Ireland Bosnia Herzegovina

Croatia Czech Republic

Lithuania

Serbia

Bulgaria

Greece

Poland Russian Federation

France Turkey

Cyprus

Prevalence of smoking*

* Self-reported smoking or CO in breath > 10 ppm

All patients: 16.0%

Men 17.6% , Women 11.1%

27%

30%

34%

38%

39%

44%

47%

47%

48%

50%

50%

50%

52%

52%

52%

52%

53%

53%

53%

55%

60%

61%

65%

71%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Spain Romania

Bosnia Herzegovina

Serbia Belgium

Slovenia

Cyprus

Ukraine

Latvia

Ireland Netherlands

Sweden Poland

Czech Republic Germany

Lithuania

Greece

Turkey

Finland

Croatia Bulgaria

United Kingdom Russian Federation

France

Prevalence of persistent smoking*

All patients: 48.6%

Men 49.3% , Women 45.4%

* Prevalence of smoking (self-reported smoking or CO in breath > 10 ppm) among patients smoking in the month prior to the index event

26%

27%

27%

29%

30%

31%

33%

36%

36%

37%

37%

37%

38%

38%

39%

40%

41%

42%

42%

43%

45%

46%

49%

51%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Serbia Bosnia Herzegovina

Sweden

Netherlands Belgium

Spain

Greece

United Kingdom

France

Germany Croatia

Poland Finland

Ukraine Ireland

Latvia

Turkey

Cyprus

Czech Republic

Bulgaria Lithuania

Romania Slovenia

Russian Federation

All patients: 37.6%

Men 35.6% , Women 43.8%

* Body Mass Index ≥ 30 kg/m²

Prevalence of obesity*

47%

48%

48%

48%

51%

51%

53%

53%

54%

55%

55%

56%

57%

58%

58%

60%

61%

62%

63%

63%

69%

72%

72%

73%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Bosnia Herzegovina Belgium Poland

Turkey Spain

Ukraine

Latvia

Netherlands

France

Serbia Ireland

Sweden Bulgaria

United Kingdom Croatia

Greece

Lithuania

Finland

Germany

Russian Federation Czech Republic

Slovenia Romania

Cyprus

All patients: 58.2%

Men 52.8% , Women 75.2%

Prevalence of central obesity*

* Waist circumference ≥ 102 cm for men or ≥ 88 cm for women

86%

81%

79%

75%

62%

69%

65%

71%

68%

65%

68%

74%

72%

71%

64%

68%

61%

58%

56%

62%

54%

44%

20%

38%

9%

11%

8%

12%

24%

16%

19%

12%

14%

17%

14%

6%

7%

7%

12%

7%

14%

15%

15%

9%

13%

14%

31%

12%

5%

9%

13%

13%

14%

15%

16%

18%

19%

19%

19%

21%

22%

22%

24%

25%

26%

27%

29%

29%

33%

42%

49%

50%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Turkey

Lithuania

Ireland

Slovenia

Russian Federation

Spain

Romania

United Kingdom

Sweden

Greece

Serbia

Bulgaria

Czech Republic

Latvia

Ukraine

Cyprus

Belgium

Croatia

France

Poland

Finland

Netherlands

Bosnia Herzegovina

Germany

Low Moderate High

Physical activity: IPAQ classification

All patients: 62.0% 13.5% 24.5%

• Blood pressure < 130/80 mmHg if feasible

• Total cholesterol <4.5 mmol/L (175 mg/dL); <4.0 mmol/L (155 mg/dL) if feasible

• LDL-C <2.5 mmol/L (100 mg/dL); <2.0 mmol/L (80 mg/dL) if feasible

• Diabetes mellitus: fasting blood glucose <6 mmol/L (110 mg/dL) and HbA1c < 6.5% if feasible

Medical Risk factors

European Guidelines on CVD Prevention- JES 2007

• Blood pressure < 140/90 mmHg, <140/80 mmHg in patients with diabetes

• LDL-C <1.8 mmol/L (70 mg/dL) or ≥50% reduction

• Diabetes mellitus: HbA1c < 7.0% (53 mmol/mol)

Medical Risk factors

European Guidelines on CVD Prevention- JES 2012

48%

49%

49%

53%

58%

58%

61%

62%

63%

65%

66%

67%

67%

70%

73%

73%

73%

73%

75%

76%

77%

81%

82%

90%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Romania

Ireland

Russian Federation

Greece

Finland

Bulgaria

Belgium

Sweden

Serbia

United Kingdom

Spain

France

Turkey

Germany

Ukraine

Croatia

Poland

Slovenia

Czech Republic

Netherlands

Lithuania

Latvia

Cyprus

Bosnia Herzegovina

JES 2012

BP ≥140/90 mmHg (≥140/80 in

patients with diabetes)

All patients: 43%

Men 42% , Women 44%

Blood pressure ≥ 130/80 mmHg

JES 2007:

BP ≥130/80 mmHg

All patients: 67%

Men 67% , Women 68%

JES 2007:

BP <130/80 mmHg

All patients: 29%

Men 29% , Women 30%

Therapeutic control of blood pressure *

* BP < 130/80 mmHg among patients using antihypertensive drugs

19%

20%

25%

27%

31%

32%

33%

34%

34%

38%

38%

39%

39%

40%

43%

44%

53%

54%

55%

58%

60%

61%

65%

66%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Spain

Finland

Slovenia

Ireland

United Kingdom

France

Belgium

Latvia

Sweden

Romania

Cyprus

Czech Republic

Poland

Netherlands

Croatia

Greece

Germany

Turkey

Serbia

Bosnia Herzegovina

Russian Federation

Ukraine

Bulgaria

Lithuania

LDL-C ≥ 2.5 mmol/L

All patients: 42%

Men 40% , Women 49%

LDL cholesterol ≥ 2.5 mmol/L

LDL-C ≥ 2.0 mmol/L

All patients: 69%

Men 67% , Women 75%

59%

66%

67%

69%

71%

71%

74%

77%

79%

79%

79%

79%

80%

81%

84%

86%

87%

88%

89%

89%

89%

92%

93%

96%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Spain

Ireland

Finland

Slovenia

Latvia

United Kingdom

France

Czech Republic

Poland

Croatia

Netherlands

Cyprus

Romania

Sweden

Greece

Belgium

Russian Federation

Ukraine

Bosnia Herzegovina

Serbia

Germany

Turkey

Bulgaria

Lithuania

All patients: 85%

Men 79% , Women 84%

LDL cholesterol ≥ 1.8 mmol/L

42%

44%

45%

46%

47%

50%

52%

53%

57%

61%

62%

63%

64%

65%

66%

67%

68%

69%

70%

75%

75%

79%

80%

84%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lithuania

Bulgaria

Ukraine

Bosnia Herzegovina

Serbia

Russian Federation

Germany

Turkey

Greece

Croatia

Cyprus

Netherlands

Czech Republic

Poland

Romania

Belgium

Latvia

France

Sweden

Ireland

United Kingdom

Slovenia

Spain

Finland

LDL-C <2.5 mmol/L

All patients: 63%

Men 65% , Women 55%

LDL cholesterol < 2.5 mmol/L in patients on lipid-lowering medication

LDL-C <2.0 mmol/L

All patients: 34%

Men 36% , Women 28%

5%

8%

10%

12%

12%

14%

14%

15%

16%

16%

20%

21%

21%

22%

22%

23%

23%

27%

31%

32%

33%

34%

35%

41%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lithuania

Bulgaria

Turkey

Germany

Serbia

Bosnia Herzegovina

Belgium

Ukraine

Greece

Russian Federation

Sweden

Netherlands

Cyprus

Croatia

Romania

Poland

Czech Republic

France

Latvia

United Kingdom

Finland

Slovenia

Ireland

Spain

All patients: 21%

Men 22% , Women 17%

LDL cholesterol < 1.8 mmol/L in patients on lipid-lowering medication

15%

19%

20%

20%

21%

21%

23%

23%

25%

25%

26%

26%

28%

31%

31%

32%

33%

33%

33%

35%

36%

36%

37%

41%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ireland Lithuania

Netherlands

Russian Federation Latvia

Bosnia Herzegovina

Ukraine

Belgium

Finland

Germany Serbia

Croatia Sweden

Bulgaria Poland

France

United Kingdom

Romania

Spain

Cyprus Czech Republic

Turkey Slovenia

Greece

All patients: 27%

Men 26% , Women 31%

Prevalence of self-reported diabetes

4%

5%

5%

6%

7%

9%

10%

10%

11%

12%

12%

15%

15%

16%

16%

16%

17%

18%

19%

19%

19%

19%

21%

23%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Sweden Finland Turkey

United Kingdom Russian Federation

Romania

France

Bulgaria

Belgium

Latvia Slovenia

Netherlands Croatia

Serbia Czech Republic

Poland

Ireland

Lithuania

Germany

Spain Ukraine

Bosnia Herzegovina Greece

Cyprus

All patients: 13%

Men 13% , Women 12%

Fasting glucose ≥ 7 mmol/L in patients without diabetes

27%

28%

30%

30%

32%

32%

34%

38%

38%

38%

39%

39%

39%

39%

40%

40%

41%

43%

44%

45%

46%

47%

55%

55%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Russian Federation Finland Ireland

Latvia Belgium

Sweden

Lithuania

United Kingdom

Serbia

Ukraine Bulgaria

Croatia Bosnia Herzegovina

Romania France

Germany

Turkey

Netherlands

Poland

Slovenia Spain

Czech Republic Greece

Cyprus

All patients: 38%

Men 37% , Women 40%

Prevalence of diabetes mellitus*

* Self-reported diabetes or fasting glucose ≥ 7 mmol/L

7%

8%

9%

10%

10%

10%

12%

12%

14%

14%

14%

15%

15%

15%

16%

16%

17%

18%

18%

19%

19%

20%

25%

27%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ukraine Croatia

Netherlands

Czech Republic Germany

Ireland

Finland

Turkey

Spain

Latvia United Kingdom

Bosnia Herzegovina Slovenia

Cyprus Belgium

Sweden

Bulgaria

France

Serbia

Romania Lithuania

Greece Poland

Russian Federation

FG <6.1 mmol/L

All patients: 15%

Men 14% , Women 15%

Fasting glucose < 6.1 mmol/L in patients with diabetes

FG <7.0 mmol/L

All patients: 31%

Men 30% , Women 31%

15%

19%

21%

23%

25%

27%

30%

31%

31%

31%

32%

33%

33%

37%

38%

39%

39%

41%

42%

43%

44%

45%

51%

62%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Turkey Croatia Cyprus

United Kingdom France

Slovenia

Czech Republic

Bulgaria

Netherlands

Ireland Ukraine

Bosnia Herzegovina Lithuania

Germany Sweden

Romania

Russian Federation

Latvia

Greece

Serbia Belgium

Spain Poland

Finland

HbA1c <6.5%

All patients: 35%

Men 36% , Women 33%

HbA1c < 6.5% in patients with diabetes

HbA1c <7.0%All patients: 53%Men 54% , Women 49%

Glucose metabolism classification based on OGTT

Impaired Glucose Tolerance

Newly detected diabetes

Normoglycaemia

Impaired Fasting Glucose

Self-reported diabetes

85%

89%

89%

91%

91%

92%

92%

92%

93%

93%

94%

96%

96%

96%

96%

97%

97%

97%

98%

98%

98%

98%

99%

99%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lithuania

United Kingdom

Germany

Bulgaria

Finland

Poland

Czech Republic

Romania

Russian Federation

Ukraine

Slovenia

Belgium

Turkey

Greece

Netherlands

Croatia

Latvia

Spain

Sweden

Bosnia Herzegovina

France

Serbia

Ireland

Cyprus

All patients: 94%

Men 94% , Women 93%

Aspirin & other antiplatelets

68%

75%

75%

78%

78%

79%

80%

80%

80%

80%

82%

83%

83%

83%

84%

84%

86%

86%

87%

88%

88%

89%

90%

94%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

United Kingdom

Netherlands

Croatia

Ukraine

Greece

Ireland

Finland

Belgium

Cyprus

Russian Federation

France

Poland

Bulgaria

Germany

Turkey

Lithuania

Czech Republic

Slovenia

Bosnia Herzegovina

Romania

Latvia

Sweden

Spain

Serbia

All patients: 83%

Men 83% , Women 83%

Beta-blockers

49%

60%

63%

64%

67%

71%

72%

73%

74%

76%

76%

78%

78%

79%

79%

80%

81%

81%

82%

82%

82%

82%

85%

87%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Belgium

Finland

Greece

Russian Federation

Netherlands

Romania

Spain

Ireland

Ukraine

Turkey

United Kingdom

Poland

Bulgaria

Slovenia

Lithuania

Croatia

Latvia

Cyprus

Sweden

Germany

France

Czech Republic

Bosnia Herzegovina

Serbia

All patients: 75%

Men 75% , Women 75%

ACE Inhibitors or ARBs

74%

75%

75%

79%

80%

81%

82%

82%

83%

84%

87%

87%

88%

89%

90%

92%

92%

93%

93%

93%

94%

94%

96%

96%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lithuania

Russian Federation

Bulgaria

Turkey

Ukraine

Croatia

Finland

Poland

Germany

United Kingdom

Netherlands

Romania

Bosnia Herzegovina

Slovenia

Sweden

Spain

Serbia

Ireland

Czech Republic

Latvia

Belgium

France

Cyprus

Greece

All patients: 86%

Men 86% , Women 84%

Statins

Finland

Czech Republic

France

Netherlands

Slovenia

EUROASPIRE II, III & IV countries

Belgium

Ireland

UK

Poland

Prevalence of smoking, obesity* and central obesity**

21%

32%

51%

20%

33%

51%

18%

39%

57%

0%

20%

40%

60%

80%

100%

Smoking Obesity Central obesity

* BMI ≥ 30 kg/m²; **Waist circumference ≥ 88 cm for women and ≥ 102 cm for men

p=0.55

p=0.007

p=0.04

EUROASPIRE IIEUROASPIRE IIIEUROASPIRE IV

Prevalence of raised BP*, elevated LDL-C** and diabetes***

54%

96%

19%

11%

52%

80%

24%

11%

45%

75%

27%

12%

0%

20%

40%

60%

80%

100%

Raised BP Elevated LDL-C Self-reported diabetes Unknown diabetes

* SBP/DBP ≥ 140/90 mmHg (≥ 140/80 mmHg for patients with diabetes); LDL ≥ 1.8 mmol/L (≥ 70 mg/dL);

***Fasting glucose ≥ 7 mmol/L (≥ 126 mg/dL) for patients without history of diabetes

p=0.01

P<0.0001

p=0.0004

EUROASPIRE IIEUROASPIRE IIIEUROASPIRE IV

p=0.78

Therapeutic control of blood pressure*, LDL-C** and diabetes***

*In patients on BP lowering drugs; **In patients on lipid-lowering drugs; *** In patients with known diabetes

p=0.01

P<0.0001

EUROASPIRE IIEUROASPIRE IIIEUROASPIRE IV

p=0.69

Cardiovascular protective drug therapies

85%

63%

42%

55%

94%

82%

72%

89%

95%

81%

71%

89%

0%

20%

40%

60%

80%

100%

Antiplatelets Beta-blockers ACE/ARB's Statins

P<0.0001

EUROASPIRE IIEUROASPIRE IIIEUROASPIRE IV

P<0.0001

P<0.0001

P<0.0001

Conclusions

• Adverse lifestyle trends in coronary patients are a major cause for concern - with no change in prevalence of smoking habits, particularly in younger patients, and a continuing increases in obesity, central obesity and diabetes

• Despite improved blood pressure and lipid management they are still not optimally controlled

• No change in glycaemic control in patients with diabetes

• Professional support is required to make lifestyle changes and manage risk factors more effectively

• All patients should have access to modern preventive cardiology programmes combining a professional lifestyle and therapeutic intervention with effective risk factor management to reduce total cardiovascular risk

Speaker

Knowing is not enough; we must apply

Willing is not enough; we must do

Speaker

Goethe

Scientific Steering Committee Executive Committee and National co-ordinators

• Kornelia Kotseva (Chair Scientific Steering Committee) (UK)

• Guy De Backer (Chair Executive Committee) (Belgium)

• Philippe Amouyel (France)

• Dirk De Bacquer (Belgium)

• Stephan Gielen (Germany)

• Aldo Maggioni (Italy)

• Malika Manini (France)

• Lars Ryden (Sweden)

• Oliver Schnell (Germany)

• Jouko Sundvall (Helsinki)

• Jaakko Tuomilehto (Finland)

• David Wood (UK)

Speaker

National Co-ordinators

• Belgium Dirk De Bacquer, Johan

De Sutter

• Bulgaria Nina Gotcheva

• Bosnia & Herzegovina Dusko

Vulic, Mirza Dilic

• Croatia Željko Reiner, Davor

Milicic

• Cyprus Evagoras Nicolaides

• The Czech Republic Jan

Bruthans, Renata Cifkova

• Finland Seppo Lehto

• France Philippe Amouyel

• Germany Peter Heuschmann,

Stefan Stöerk

• Greece Ioannis Goudevenos

• Ireland David Moore

• Latvia Andrejs Erglis

• Lithuania Aleksandras

Laucevicius

• The Netherlands Jaap Deckers

• Poland Andrzej Pajak

• Romania Dan Gaita

• Russia Rafael Oganov, Nana

Pogosova

• Serbia Dragan Lovic

• Slovenia Zlatko Fras

• Spain Almudena Castro Conde

• Sweden Martin Stagmo, Viveca

Gyberg

• Turkey Lâle Tokgözoğlu

• Ukraine Marina Dolzhenko

• United Kingdom David Wood Speaker

Co-ordinating centreCardiovascular Medicine, International Centre for Circulatory Health

Imperial College, London, UK

• David Wood

• Kornelia Kotseva

• Catriona Jennings

• Agnieszka Adamska

Data management centreEURObservational Research Programme, European Heart House, Sophia-

Antipolis, France

• Malika Manini, Head of EORP Department

• Marème Konte, Data Manager

• Myriam Glemot, Programme Assistant

Statistical Centre Department of Public Health, Ghent University, Belgium

• Dirk De Bacquer

Speaker

Diabetes centre

Department of Cardiology Karolinska University Hospital Stockholm,

Sweden

• Lars Ryden

• Jaakko Tuomilehto

• Oliver Schnell

• Viveca Gyberg

Central LaboratoryLaboratory of Analytical Biochemistry, National Public Health Institute

Helsinki, Finland

• Jouko Sundvall

Speaker

EUROASPIRE IV

Sponsors

GlaxoSmithKline

Bristol-Myers Squibb/ Emea Sarl

AstraZeneca

F. Hoffmann La Roche

Merck Sharp & Dohme

Finland

Czech RepublicFrance

Germany

Netherlands

SloveniaSpain

EUROASPIRE IV Countries

Belgium

Ireland

UK

Greece

Poland

Latvia

Lithuania

Romania

Russia

Croatia

Bulgaria

Cyprus

Turkey

Serbia Bosnia

Herzegovina Ukraine

Sweden

13%

30%

30%

40%

40%

40%

40%

44%

45%

46%

47%

48%

50%

55%

55%

57%

58%

61%

62%

62%

64%

65%

66%

71%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Slovenia Croatia

Spain

Belgium Cyprus

Greece

France

Latvia

Netherlands

Czech Republic Bosnia Herzegovina

Sweden United Kingdom

Finland Russian Federation

Poland

Serbia

Lithuania

Germany

Ukraine Bulgaria

Turkey Ireland

Romania

Intention to quit smoking within the coming 6 months*

All patients: 50.9%

Men 52.0% , Women 45.5%

* among patients still smoking at the time of interview

25%

39%

41%

45%

46%

55%

56%

59%

59%

59%

63%

64%

65%

67%

67%

68%

70%

71%

72%

73%

75%

78%

79%

86%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Finland Cyprus

Sweden

Latvia Turkey

Lithuania

France

Croatia

Czech Republic

Ukraine Poland

Bosnia Herzegovina Spain

Netherlands Bulgaria

Russian Federation

Ireland

Greece

Serbia

Germany United Kingdom

Belgium Romania

Slovenia

All patients: 61.9%

Men 62.0% , Women 61.5%

Obese patients* considering to lose weight during next

6 months

* Body mass index ≥ 30 kg/m² at time of interview

44%

58%

58%

69%

69%

77%

80%

84%

86%

87%

87%

88%

92%

94%

95%

96%

96%

96%

97%

98%

99%

99%

100%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

United Kingdom

Turkey

Ireland

Belgium

Netherlands

Greece

Sweden

Croatia

Czech Republic

Spain

Germany

France

Romania

Russian Federation

Ukraine

Bulgaria

Finland

Bosnia Herzegovina

Cyprus

Latvia

Lithuania

Poland

Serbia

Slovenia

All patients: 87%

Men 86% , Women 88%

Blood pressure level awareness

15%

18%

22%

23%

24%

30%

32%

37%

38%

39%

52%

53%

60%

61%

66%

67%

70%

72%

74%

81%

82%

82%

84%

93%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

France

Belgium

Turkey

Spain

Germany

Croatia

Netherlands

Czech Republic

United Kingdom

Sweden

Romania

Bulgaria

Cyprus

Latvia

Ukraine

Finland

Greece

Lithuania

Ireland

Russian Federation

Poland

Slovenia

Bosnia Herzegovina

Serbia

All patients: 49%

Men 47% , Women 57%

Total cholesterol level awareness

8%

22%

25%

28%

28%

33%

39%

41%

43%

45%

47%

51%

54%

56%

57%

60%

61%

64%

64%

74%

77%

85%

95%

96%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Belgium

Netherlands

United Kingdom

Germany

France

Turkey

Ireland

Croatia

Spain

Latvia

Sweden

Bulgaria

Finland

Czech Republic

Ukraine

Romania

Greece

Bosnia Herzegovina

Lithuania

Cyprus

Russian Federation

Poland

Serbia

Slovenia

All patients: 50%

Men 47% , Women 57%

Glucose level awareness

14%

20%

25%

25%

30%

30%

31%

33%

34%

34%

35%

36%

38%

41%

41%

42%

44%

46%

48%

50%

55%

56%

56%

60%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Spain

Finland

Slovenia

Ireland

Belgium

France

Sweden

United Kingdom

Latvia

Croatia

Greece

Romania

Poland

Czech Republic

Cyprus

Netherlands

Bosnia Herzegovina

Serbia

Germany

Turkey

Bulgaria

Ukraine

Russian Federation

Lithuania

TC≥ 4.5 mmol/L

All patients: 39%

Men 36% , Women 49%

Total cholesterol ≥ 4.5 mmol/L

TC≥ 4.0 mmol/L

All patients: 60%

Men 56% , Women 71%

49%

51%

52%

54%

56%

58%

59%

59%

60%

60%

62%

67%

67%

68%

70%

70%

71%

71%

73%

73%

76%

79%

84%

87%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lithuania

Ukraine

Russian Federation

Bulgaria

Serbia

Germany

Turkey

Bosnia Herzegovina

Cyprus

Netherlands

Czech Republic

Greece

Poland

Latvia

Belgium

Romania

France

Croatia

Sweden

United Kingdom

Ireland

Slovenia

Finland

Spain

TC < 4.5 mmol/L

All patients: 66%

Men 69% , Women 56%

Total cholesterol < 4.5 mmol/L in patients on lipid-lowering medication

TC < 4.0 mmol/L

All patients: 44%

Men 47% , Women 32%