Daijiworld Media Network - London
London, Sep 12: Most people with established coronary heart disease across Europe are failing to meet recommended targets for preventing further cardiovascular events, according to findings from the major international EUROASPIRE VI study.
The survey of 8,590 patients found that 82.7% had LDL cholesterol levels above the recommended target, while 59.8% were above the recommended blood pressure target. Access to cardiac rehabilitation also varied substantially across Europe, with participation lowest in regions facing the greatest cardiovascular risk.
People with established coronary heart disease remain at increased risk of further cardiovascular events, making control of cholesterol, blood pressure, smoking, body weight and physical activity an important part of secondary prevention.
The observational EUROASPIRE VI study assessed how closely clinical practice across Europe reflects recommended approaches to cardiovascular prevention and rehabilitation.
The study included 8,590 patients with coronary heart disease treated at 160 hospitals across 27 countries between September 2024 and February 2026. Countries were classified as having low, moderate or high cardiovascular risk based on World Health Organization cardiovascular mortality data.
Researchers assessed lifestyle factors, cardiovascular risk-factor control, medication use and participation in cardiac rehabilitation.
Despite having established coronary heart disease, many patients had poorly controlled cardiovascular risk factors. Overall, 82.7% had LDL cholesterol of at least 1.4 mmol/L, placing them above the recommended target.
Almost six in 10 patients, or 59.8%, were above the recommended blood pressure target of less than 130/80 mmHg.
Lifestyle-related risk factors were also widespread. About one-third of patients, or 32%, were living with obesity, while 33.5% reported low levels of physical activity. Another 17.1% continued to smoke.
Diabetes was previously diagnosed in 32.8% of participants. Among these patients, 42.2% had HbA1c levels of at least 7%, indicating that recommended blood glucose targets were frequently not achieved.
Chronic kidney disease, another important cardiovascular risk factor, was present in 30.6% of participants.
Researchers found that the overall burden of cardiovascular risk factors was consistently highest among patients living in countries classified as having high cardiovascular risk.
The study also highlighted major differences in access to cardiac rehabilitation, which supports recovery and secondary prevention through exercise, education, lifestyle modification and management of cardiovascular risk factors.
Only 29.1% of patients had attended at least one cardiac rehabilitation session. Participation varied dramatically between countries, ranging from 0% to 79%.
A significant geographical divide was also identified. Cardiac rehabilitation attendance was 55.9% in low-risk regions and 29.7% in moderate-risk regions, but fell to just 10.2% in high-risk regions.
Patients who participated in cardiac rehabilitation generally had healthier lifestyles, better control of cardiovascular risk factors and greater use of heart-protective medicines.
However, researchers cautioned that the observational nature of EUROASPIRE VI means the study cannot establish that cardiac rehabilitation itself directly caused the better outcomes. Patients who participate in rehabilitation may differ from non-participants in other important ways.
The findings nevertheless point to a substantial gap between recommended cardiovascular prevention measures and routine clinical care, particularly in European regions carrying the greatest disease burden.
Researchers described the pattern as evidence of "inverse care", in which patients living in the highest-risk regions have the lowest participation in cardiac rehabilitation despite potentially having the greatest need.
The authors concluded that improving the implementation of secondary prevention measures and expanding access to cardiac rehabilitation will be essential to addressing persistent inequalities in cardiovascular care across Europe.