Abstract

Within the next 20 years cardiovascular disease is expected to become the leading cause of premature death and overall mortality worldwide. Because cardiovascular disease is multifactorial in nature, global risk assessment is required. Treatments for cardiovascular disease are among the most evidence-based therapies available to clinicians, and evidence of treatment benefit has resulted in clear guidelines regarding which interventions to use. Nevertheless, there is considerable variation within health care systems with regard to the diagnosis, management and follow-up of patients with cardiovascular disease. Two recent European surveys, conducted among patients and physicians, have provided evidence of factors that may contribute to this variability in clinical performance.

References

[1]
Murray
CJ
, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study.
Lancet
 .
1997
;
349
:
1498
–1504
[2]
Tunstall-Pedoe
H
, Kuulasmaa K, Mahoncn M, Toloncn H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortal ity: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease.
Lancet
 .
1999
;
353
:
1547
–1557
[3]
Murray
CJ
, Lopez AD. Global and regional cause-of-death patterns in 1990.
Bull World Health Organ
 .
1994
;
72
:
447
–480
[4]
Stamler
J
, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.
Diabetes Care
 .
1993
;
16
:
434
–444
[5]
Wood
D
, Durrington P, Poulter N. Joint British recommendations on prevention of coronary heart disease in clinical practice.
Heart
 .
1998
;
80
(suppl 1):
S1
–29
[6]
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Anonymous
Arch Intern Mcd
 .
1997
;
157
:
2413
–2446
[7]
Collins
R
, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context.
Lancet
 .
1990
;
335
:
827
–838
[8]
National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Anonymous
Arch Intern Med
 .
1993
;
153
:
186
–208
[9]
Wang
JG
, Staessen JA. The benefit of treating isolated systolic hypertension.
Curr Hypertens Rep
 .
2001
;
3
:
333
–339
[10]
Wilking
SV
, Belanger A, Kannel WB, D'Agostino RB, Steel K. Determinants of isolated systolic hypertension.
JAMA
 .
1988
;
260
:
3451
–3515
[11]
Verschuren
WM
, Jacobs DR, Bloemberg BP, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.
JAMA
 .
1995
;
274
:
131
–136
[12]
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
Lancet
 .
1994
;
344
:
1383
–1389
[13]
Shepherd
J
, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypcrcholesterolemia. West of Scotland Coronary Prevention Study Group.
N Engl J Med
 .
1995
;
333
:
1301
–1307
[14]
Sacks
FM
, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators.
N Engl J Med
 .
1996
;
335
:
1001
–1009
[15]
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.
N Engl J Med
 .
1998
;
339
:
1349
–1357
[16]
Downs
JR
, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study.
JAMA
 .
1998
;
279
:
1615
–1622
[17]
Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Anonymous
Eur Heart J
 .
1998
;
19
:
1434
–1503
[18]
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Anonymous
JAMA
 .
2001
;
285
:
2486
–2497
[19]
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38.
BMJ
 .
1998
;
317
:
703
–713
[20]
Qureshi
AI
, Suri ME, Guterman LIZ, Hopkins LN. Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey.
Arch Intern Med
 .
2001
;
161
:
1621
–1628
[21]
Pearson
TA
, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals.
Arch Intern Med
 .
2000
;
160
:
459
–467
[22]
EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II Euro Heart Survey Programme.
Eur Heart J
 .
2001
;
22
:
554
–572
[23]
EUROASPIRE Study Group. EUROASPIRE A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. EUROASPIRE Study Group. European Action on Secondary Prevention through Intervention to Reduce Events.
Eur Heart J
 .
1997
;
18
:
1569
–1582
[24]
Hobbs
FDR
, Erhardt L. Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey: physician perceptions and attitudes towards cholesterol guidelines.
Family Practice
 .
2002
;: in press
[25]
Peters
TJ
, Montgomery AA, Fahey T. How accurately do primary health care professionals use cardiovascular risk tables in the management of hypertension?
Br J Gen Pract
 .
1999
;
49
:
987
–988
[26]
Grover
SA
, Lowensteyn I, Esrey KL, Steinert Y, Joseph L, Abrahamowicz M. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study.
BMJ
 .
1995
;
310
:
975
–978
[27]
Hibble
A
, Kanka D, Pencheon D, Pooles F. Guidelines in general practice: the new Tower of Babel?
BMJ
 .
1998
;
317
:
862
–863
[28]
Hansson
L
, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group.
Lancet
 .
1998
;
351
:
1755
–1762
[29]
Erhardt
L
, Hobbs FDR. Reassessing European Attitudes about Cardiovascular Treatment (REACT) general population survey.
J Int Clin Pract
 .
2002
;: in press