In Reply

Trends in Cardiovascular Risk Factors Among Patients With Coronary Heart Disease: Results From the EUROASPIRE I, II, and III Surveys in the Münster Region by Dr. med. Christof Prugger, Dr. med. Jan Heidrich, Dr. rer. nat. Jürgen Wellmann, Dr. med. Ralf Dittrich, Prof. Dr. med. Stefan-Martin Brand, Dr. rer. nat. Ralf Telgmann, Prof. Dr. med. Günter Breithardt, Dr. med. Holger Reinecke, Prof. Dr. med. Hans Scheld, Dr. med. Peter Kleine-Katthöfer, Prof. Dr. med. Peter U. Heuschmann, Prof. Dr. med. Ulrich Keil in volume 17/2012

In their letter to the editor, Korbmacher and Schäfer rightly point out the importance of psychosomatic roots of cardiovascular risk factors in patients with coronary heart disease (CHD). Psychosocial factors such as anxiety and depression, but also a low social status, lacking social support, workplace or family stress, hostility, and a type D personality impair measures to improve lifestyles and compliance with medication therapy; current guidelines for the prevention of cardiovascular disease in clinical practice therefore recommend to collect information on psychosocial risk factors via the medical history or by using standardized questionnaires and to aspire to individually tailored treatment (1). In the context of the EUROASPIRE III survey, the possible factors influencing cardiovascular risk in patients with CHD from 22 European regions including Münster were thoroughly investigated (2, 3). Patients with anxiety or depression disorder at the time of the interview reported to a far lesser degree that they had changed their lifestyle since the coronary event. Depressive symptoms were associated with a higher body mass index and waist circumference, as well as more cases of comorbid diabetes. Women, diabetes patients, and patients after aortocoronary bypass surgery achieved the target values for smoking, blood pressure, and cholesterol to a far lesser extent. A university education, participation in a cardiac rehabilitation program, and specialized cardiology treatment, however, were associated with better control of these risk factors. Future prevention strategies should take these study results into account and aim for improved implementation of the recommendations for cardiovascular prevention in CHD patients in Europe.

DOI: 10.3238/arztebl.2012.0733b

Dr. med. Christof Prugger, MSc

Prof. Dr. med. Ulrich Keil, PhD

Institut für Epidemiologie und Sozialmedizin, Universität Münster

Conflict of interest statement
The authors declare that no conflict of interest exists

References

1. Perk J, De Backer G, Gohlke H, et al.: European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635–701.

2. Pajak A, Jankowski P, Kotseva K, Heidrich J, de Smedt D, De Bacquer D; on behalf of the EUROASPIRE Study Group: Depression, anxiety, and risk factor control in patients after hospitalization for coronary heart disease: the EUROASPIRE III Study. Eur J Prev Cardiol 2012 Mar 6. [Epub ahead of print]

3. Cooney MT, Kotseva K, Dudina A, De Backer G, Wood D, Graham I, on behalf of the EUROASPIRE Investigators: Determinants of risk factor control in subjects with coronary heart disease : a report from the EUROASPIRE III investigators. Eur J Prev Cardiol 2012 Apr 18. [Epub ahead of print]

4. Prugger C, Heidrich J, Wellmann J, et al.: Trends in cardiovascular risk factors among patients with coronary heart disease: results from the EUROASPIRE I, II, and III surveys in the Münster region. Dtsch Arztebl Int 2012; 109(17): 303–10.