Structured cardiac-prevention programmes must be put in place in the Republic if risk factors for heart disease such as obesity and smoking are to be reduced, a leading specialist has said.
University College Dublin medical graduate Dr Susan Connolly, who is a consultant cardiologist at the Hammersmith hospitals NHS Trust in London and a specialist in cardiac prevention, told doctors at the West of Ireland Cardiology Foundation (Croí) conference of research showing obesity levels "skyrocketing" even among patients with established heart disease.
Three separate Euroaspire surveys of 8,500 patients with coronary heart disease carried out in eight European countries over the past 12 years showed no improvement in lifestyle risk factors, she said.
When the first survey was undertaken in 1995, one-quarter of patients with coronary artery disease were classified as obese; now the proportion of patients with a body mass index (BMI) of 30 or greater has risen to a third.
The waist lines (central obesity) of people with a history of previous cardiac surgery, angioplasty (coronary stenting) or a heart attack were also increasing steadily, according to Dr Connolly.
Describing the time trends in lifestyle risk factors as disappointing, she said: "These adverse trends in body weight and distribution contribute to a worsening of other risk factors such as raised blood pressure, high cholesterol and diabetes."
Smoking levels have not changed over the 12-year period, with almost one-fifth of patients with established coronary disease continuing to smoke cigarettes. And one-half of those surveyed had blood pressure above the recommended target of 140/90 mm Hg.
Dr Connolly said the failure to improve blood pressure management occurred despite large increases in prescriptions for all categories of anti-hypertensive drugs.
"The explanation is probably the rising prevalence of overweight and obesity in these patients," she said.
In contrast, the management of cholesterol has dramatically improved over the three surveys.
The proportion of patients achieving cholesterol targets has risen from 11 per cent to 75 per cent, mirroring a four-fold increase in prescriptions by doctors of lipid-lowering drugs (statins).
In response to the lack of progress in lifestyle modification, Dr Connolly and other European experts set up the Euroaction programme, which tackled the cardiovascular health of more than 10,000 people either with a history of coronary disease or at high risk of developing a heart attack.
Including patients and family members in a nurse-managed multidisciplinary team approach, the latest results from Euroaction show significant lifestyle improvements and risk factor reduction among patients.
Some three-quarters of patients achieved the recommended fruit and vegetable consumption of five standard portions a day. Physical activity targets of 30-45 minutes of exercise, four to five times per week were achieved by twice as many Euroaction patients as a similar group not included in the programme.
And blood pressure readings of 140/90mm Hg or less were achieved by almost three-quarters of patients with established cardiac disease and by more than two-thirds of those rated as high risk of developing heart disease in the future.
The Euroaction project took place in hospitals and general practices across Europe.
Dr Connolly described a community-based initiative which she has set up in the Bromley NHS Trust in London where 250 families are availing of a coronary disease prevention programme based in a local health spa.
"There should be structured cardiac-preventive programmes in Ireland for all patients who need it. "These structured programmes should have a multidisciplinary team, including a nurse, dietician and psychologist, with the emphasis placed on lifestyle modifications," Dr Connolly said.