Prevention of cardiovascular disease and diabetes on a population level

Background: Cardiovascular disease and diabetes are responsible for just over half of the global mortality, and these diseases are expected to increase. The upsurge is due to increased longevity and a westernisation of the global lifestyle. Preventive efforts have proven effective and are believed to be the only way to curb the rapid increase of these diseases. Still the implementations of preventive measures are reported as underused.

Aims: to study prevention by: 1. Investigating the perception of key policymakers on cardiovascular disease; 2. Examining if screening for diabetes online is feasible using FINDRISC; 3. Assessing management of patients with coronary artery disease and diabetes; andd 4. Determining the best screening test for dysglycaemia in patients with coronary artery disease.

Policymakers’ perception of cardiovascular disease: Policymakers in Europe agreed that national patterns of cardiovascular disease and its prevention are far from satisfactory. A similar rating of the perceived proximity to a specific target in two countries did not necessarily reflect a similar national situation when compared to available statistics on the actual situation. Policymakers had diverging opinions on what actions to take and what obstacles to overcome to improve population health.Feasibility of using FINDRISC as an online questionnaire It was feasible to incorporate a diabetes risk score such as FINDRISC in an online survey. A reasonable response rate was achieved and a group that could benefit from preventive intervention programs was identified.

Management of patients with coronary artery disease and diabetes: A large proportion of the patients are far from guideline recommended evidence based treatment targets for blood pressure, LDL-cholesterol and HbA1c. A potential reason is a consistent, relatively low combined use of four selected cardioprotective drug therapies and/or lack of dose titration. There was, however, some improvement over time.

Screening for dysglycaemia in patients with coronary artery disease: Screening by means of an oral glucose tolerance test (OGTT) identified the largest number of patients with undetected diabetes. The overlap in case-detection between fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) and HbA1c was small. Screening with HbA1c alone would have left 83% of those with diabetes undetected. The total proportion of patients identified with diabetes and other forms of dysglycaemia varied from 90% using the American Diabetes Association’s criteria for FPG + HbA1c, which may be an overestimate, to 73% using WHO criteria for OGTT = FPG + 2hPG, which may be more realistic.

Conclusion: Creating a coherent knowledge base and action agenda regarding prevention among key policy-makers should be given high priority in future population based prevention programmes. The online questionnaire FINDRISC is a feasible way to identify high-risk individuals as well as risk typing populations. Despite some improvement, patients with coronary artery disease and diabetes are not managed according to best available knowledge. Efforts to improve this are needed to improve their still dismal prognosis. An oral glucose tolerance test has the best capacity to screen-detect dysglycaemia in patients with coronary artery disease.

List of scientific papers

I. Viveca Gyberg, Lars Rydén. Policymakers’ perceptions of cardiovascular health in Europe. European Journal of Cardiovascular Prevention Rehabilitation. 2011;18:745-75
https://doi.org/10.1177/1741826710397487.

II. Viveca Gyberg, Dan Hasson, Jaakko Tuomilehto, Lars Rydén. Measuring risk online -Feasibility of using FINDRISC in an online workplace survey. Primary Care Diabetes. 2012;6:103-107
https://doi.org/10.1016/j.pcd.2011.12.003.

III. Viveca Gyberg, Kornelia Kotseva, Jean Dallongeville, Guy De Backer, Linda Mellbin, Lars Rydén, David Wood, Dirk De Bacquer for the EUROASPIRE Study Group. Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III cross-sectional study. European Journal of Preventive Cardiology. E-published ahead of print 2014 April 1
https://doi.org/10.1177/2047487314529353

IV. Viveca Gyberg, Dirk De Bacquer, Guy De Backer, Catriona Jennings, Kornelia Kotseva, Linda Mellbin, Oliver Schnell, Jaakko Tuomilehto, David Wood, Lars Rydén. Improved but still not satisfactory management of patients with coronary artery disease and diabetes : A report from EUROASPIRE IV. [Manuscript]

V. Viveca Gyberg, Dirk de Bacquer, Kornelia Kotseva, Guy de Backer, Oliver Schnell, Jouko Sundvall, Jaakko Tuomilehto, David Wood, Lars Rydén. Screening for dysglycaemia in patients with coronary artery disease as reflected by fasting glucose, oral glucose tolerance test and HbA1c. [Manuscript]