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Perk, Joep
Publications (10 of 58) Show all publications
Munkhaugen, J., Hjelmesaeth, J., Otterstad, J. E., Helseth, R., Sollid, S. T., Gjertsen, E., . . . Dammen, T. (2018). Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study. BMC Cardiovascular Disorders, 18, Article ID 160.
Open this publication in new window or tab >>Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study
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2018 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, article id 160Article in journal (Refereed) Published
Abstract [en]

Background: Understanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7-6.4%), and type 2 diabetes. Methods: A cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2-36 months follow-up. Results: In all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0. 002) and insomnia (Odds Ratio 2.0, p= 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 33, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0. 003). In patients with type 2 diabetes, a higher HbA(1c) level was associated with ethnic minority background (standardized beta [beta] 0.19, p = 0.005) and low drug adherence (0 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA(1c) was associated with larger waist circumference (beta 0.13, p < 0.001), smoking (beta 0.18, p < 0.001), hypertension (beta 0.08, p = 0.04), older age (beta 0.16, p < 0.001), and non-participation in cardiac rehabilitation (beta 0.11, p = 0.005). Conclusions: Along with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Secondary prevention, Coronary heart disease, Type 2 diabetes, Prediabetes, HbA(1c), Risk factor control, Glycaemic control, Psychosocial factors
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-77377 (URN)10.1186/s12872-018-0896-z (DOI)000440660400001 ()30075751 (PubMedID)
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-30Bibliographically approved
Borghi, C., Rodriguez-Artalejo, F., De Backer, G., Dallongeville, J., Medina, J., Nuevo, J., . . . Halcox, J. P. (2018). Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study. International Journal of Cardiology, 253, 167-173
Open this publication in new window or tab >>Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 253, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk. Methods: This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients had at least one CV risk factor but no clinical CV disease. Ten-year risk of CV death was estimated using SCORE-HDL and SCORE algorithms, categorized as low (<1%), intermediate (1% to <5%), high (>5% to <10%) or very high (>10%). Results: Mean serum sUA levels increased significantly with increasing CV death risk category in the overall population and in subgroups stratified by diuretics use or renal function (all P < 0.0001). Multivariate ordinal logistic regression analyses, adjusted for factors significantly associated with CV death risk in univariate analyses (study country, body mass index, number of CV risk factors and comorbidities, use of lipid lowering therapies, antihypertensives and antidiabetics), showed a significant association between sUA levels and SCORE-HDL category in the overall population (OR: 1.39 [95% CI: 1.34-1.44]) and all subgroups (using diuretics: 1.32 [1.24-1.40]; not using diuretics: 1.46 [1.39-1.53]; estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m(2): 1.30 [1.22-1.38]; eGFR >= 60 ml/min/1.73 m(2): 1.44 [1.38-1.51]; all P < 0.0001). Similar results were obtained when using SCORE. Conclusions: Higher sUA levels are associated with progressively higher 10-year CV death risk score in patients with at least one CV risk factor but no CV disease. (c) 2017 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Serum uric acid, Cardiovascular risk, European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA), Systematic COronary Risk Evaluation (SCORE), Systematic COronary Risk Evaluation algorithm including high-density lipoprotein cholesterol (SCORE-HDL)
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-70244 (URN)10.1016/j.ijcard.2017.10.045 (DOI)000419221500034 ()29306459 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-01-30Bibliographically approved
Karjalainen, T., Adiels, M., Björck, L., Cooney, M.-T., Graham, I., Perk, J., . . . Eliasson, M. (2017). An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-2014. European Journal of Preventive Cardiology, 24(1), 103-110
Open this publication in new window or tab >>An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-2014
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 1, p. 103-110Article in journal (Refereed) Published
Abstract [en]

Background Risk prediction models for cardiovascular death are important for providing advice on lifestyle and in decision-making regarding primary preventive drug treatment. The latest Swedish version of the Systematic COronary Risk Evaluation (SCORE 2015) has yet not been tested in the population. Objective The objective of this study was to estimate the prevalence of high and very high risk of fatal cardiovascular disease (CVD) of the current population according to 2015 SCORE Sweden and to evaluate the predictive accuracy of the 2003 Swedish version of SCORE (2003 SCORE Sweden) and 2015 SCORE Sweden in a population with declining CVD mortality. Methods We estimated the high and very high risk group for cardiovascular death for individuals 40-65 years of age in the 2014 Northern Sweden MONICA population survey excluding subjects with known diabetes or previous CVD (n=813). Using the 1999 MONICA survey (n=3347) followed up for 10 years for CVD mortality, we assessed the calibration of both 2003 and 2015 SCORE Sweden. Results In 2014 2.6% of the population was considered at high or very high risk for fatal CVD, 95% were men and 76% were in the age group 60-65 years. Including subjects with a single markedly elevated risk factor, known diabetes or CVD, 12% of the population was at high or very high risk. During 10 years of follow-up of the 1999 cohort, 34 CVD deaths (24 men and 10 women) occurred. The 2003 SCORE overestimated the risk of death from CVD (ratio predicted/observed 2.3, P<0.001) whereas the 2015 SCORE slightly overestimated the number of deaths (predicted/observed 1.3, P=0.12). The 2015 SCORE predicted more accurately than the 2003 SCORE the number of deaths in the different risk and age categories. Conclusion The 2015 SCORE Sweden more adequately than 2003 SCORE Sweden predicts the number of deaths. In 2014, the proportion of high-risk individuals is small in northern Sweden. The main use of 2015 SCORE Sweden would therefore be as an educational tool between the physician and people without diabetes or CVD in a consultation regarding cardiovascular risk.

Keywords
Cardiovascular disease, cohort study, mortality, SCORE, prediction
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-60154 (URN)10.1177/2047487316673142 (DOI)000390556800009 ()
Available from: 2017-01-24 Created: 2017-01-24 Last updated: 2018-05-31Bibliographically approved
Munkhaugen, J., Sverre, E., Otterstad, J. E., Peersen, K., Gjertsen, E., Perk, J., . . . Husebye, E. (2017). Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients. European Journal of Preventive Cardiology, 24(9), 981-989
Open this publication in new window or tab >>Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, p. 981-989Article in journal (Refereed) Published
Abstract [en]

Objective Understanding the determinants of low-density lipoprotein cholesterol (LDL-C) control constitutes the basis of modelling interventions for optimal lipid control and prognosis. We aim to identify medical and psychosocial (study) factors associated with unfavourable LDL-C control in coronary patients. Methods A cross-sectional explorative study used logistic and linear regression analysis to investigate the association between study factors and LDL-C in 1095 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records, a comprehensive self-report questionnaire, clinical examination and blood samples after 2-36 months follow-up. Results Fifty-seven per cent did not reach the LDL-C target of 1.8 mmol/l at follow-up. Low socioeconomic status and psychosocial factors were not associated with failure to reach the LDL-C target. Statin specific side-effects (odds ratio 3.23), low statin adherence (odds ratio 3.07), coronary artery by-pass graft operation as index treatment (odds ratio 1.95), ≥ 1 coronary event prior to the index event (odds ratio 1.81), female gender (odds ratio 1.80), moderate- or low-intensity statin therapy (odds ratio 1.62) and eating fish < 3 times/week (odds ratio 1.56) were statistically significantly associated with failure to reach the LDL-C target, in adjusted analyses. Only side-effects (standardized β 0.180), low statin adherence (β 0.209) and moderate- or low-intensity statin therapy (β 0.228) were associated with LDL-C in continuous analyses. Conclusions Statin specific side-effects, low statin adherence and moderate- or low-intensity statin therapy were the major factors associated with unfavourable LDL-C control. Interventions to improve LDL-C should ensure adherence and prescription of sufficiently potent statins, and address side-effects appropriately. © European Society of Cardiology 2017.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Coronary heart disease, Drug adherence, Low-density lipoprotein cholesterol, Psychosocial factors, Secondary prevention
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-64660 (URN)10.1177/2047487317693134 (DOI)000401147700011 ()28196429 (PubMedID)2-s2.0-85019243441 (Scopus ID)
Available from: 2017-06-02 Created: 2017-06-02 Last updated: 2017-07-19Bibliographically approved
Sverre, E., Peersen, K., Otterstad, J. E., Gullestad, L., Perk, J., Gjertsen, E., . . . Munkhaugen, J. (2017). Optimal blood pressure control after coronary events: the challenge remains. Journal of the American Society of Hypertension : JASH, 11(12), 823-830
Open this publication in new window or tab >>Optimal blood pressure control after coronary events: the challenge remains
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2017 (English)In: Journal of the American Society of Hypertension : JASH, ISSN 1933-1711, E-ISSN 1878-7436, Vol. 11, no 12, p. 823-830Article in journal (Refereed) Published
Abstract [en]

We identified sociodemographic, medical, and psychosocial factors associated with unfavorable blood pressure (BP) control in 1012 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. This cross-sectional study collected data from hospital records, a comprehensive self-report questionnaire, clinical examination, and blood samples after 2-36 (mean 17) months follow-up. Forty-six percent had unfavorable BP control (>= 140/90 [80 in diabetics] mm Hg) at follow-up. Low socioeconomic status and psychosocial factors did not predict unfavorable BP control. Patients with unfavorable BP used on average 1.9 (standard deviation 1.1) BP-lowering drugs at hospital discharge, and the proportion of patients treated with angiotensin inhibitors and beta-blockers decreased significantly (P < .001) from discharge to follow-up. Diabetes (odds ratio [OR] 2.4), higher body mass index (OR 1.05 per 1.0 kg/m(2)), and older age (OR 1.04 per year) were significantly associated with unfavorable BP control in adjusted analyses. Only age (standardized beta [beta] 0.24) and body mass index (beta 0.07) were associated with systolic BP in linear analyses. We conclude that BP control was insufficient after coronary events and associated with obesity and diabetes. Prescription of BP-lowering drugs in hypertensive patients seems suboptimal. Overweight and intensified drug treatment thus emerge as the major factors to target to improve BP control. (C) 2017 American Society of Hypertension. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Antihypertensive treatment, medical factors, psychosocial factors, secondary prevention
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-69796 (URN)10.1016/j.jash.2017.10.007 (DOI)000418878300006 ()29128603 (PubMedID)
Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-01-12Bibliographically approved
Halcox, J. P., Banegas, J. R., Roy, C., Dallongeville, J., De Backer, G., Guallar, E., . . . Borghi, C. (2017). Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovascular Disorders, 17, Article ID 160.
Open this publication in new window or tab >>Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study
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2017 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, article id 160Article in journal (Refereed) Published
Abstract [en]

Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol. Methods: This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Results: Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. Conclusions: A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Atherogenic dyslipidemia, Cardiovascular disease, Epidemiology, Risk factors/global assessment
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-66905 (URN)10.1186/s12872-017-0591-5 (DOI)000403641900002 ()
Available from: 2017-07-14 Created: 2017-07-14 Last updated: 2018-01-31Bibliographically approved
Perk, J. (2017). The 2016 version of the European Guidelines on Cardiovascular Prevention. European Heart Journal - Cardiovascular Pharmacotherapy, 3(1), 9-10
Open this publication in new window or tab >>The 2016 version of the European Guidelines on Cardiovascular Prevention
2017 (English)In: European Heart Journal - Cardiovascular Pharmacotherapy, ISSN 2055-6837, E-ISSN 2055-6845, Vol. 3, no 1, p. 9-10Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2017
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-72194 (URN)10.1093/ehjcvp/pvw030 (DOI)000397163700005 ()28062656 (PubMedID)
Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-04-04Bibliographically approved
Peersen, K., Munkhaugen, J., Gullestad, L., Liodden, T., Moum, T., Dammen, T., . . . Otterstad, J. E. (2017). The role of cardiac rehabilitation in secondary prevention after coronary events. European Journal of Preventive Cardiology, 24(13), 1360-1368
Open this publication in new window or tab >>The role of cardiac rehabilitation in secondary prevention after coronary events
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 13, p. 1360-1368Article in journal (Refereed) Published
Abstract [en]

Background Coronary risk factor control in Europe is suboptimal and there are large variations in the nature of cardiac rehabilitation (CR) programmes offered to coronary heart disease patients. We aim to explore characteristics and risk factor control in patients recruited from two neighbouring hospitals offering CR with different content. Methods In a cross-sectional study, 1127 Norwegian patients hospitalized with acute myocardial infarction and/or a revascularization procedure attended a clinical visit and completed a questionnaire at 2-36 months' follow-up. The hospital of Vestfold provides comprehensive CR, while the hospital of Drammen provides mainly exercise-based CR. Results At follow-up, patients in Vestfold performed more physical activity (p=0.02), were less obese (p=0.02) and reported better medication adherence (p=0.02) than patients in Drammen. The perceived need for information and follow-up was higher in Drammen than Vestfold (p<0.001). The CR participation rate in Vestfold was 75% compared with 18% in Drammen. CR participation in Vestfold was associated with higher prevalence of smoking cessation (p=0.001), lower low-density lipoprotein cholesterol (p=0.01) and better medication adherence (p=0.02) compared with non-CR, in adjusted analyses. No differences in diet, body weight, or blood pressure control were found between CR and non-CR. Conclusions Vestfold, with comprehensive CR, had a higher participation rate and more risk factors on target than Drammen. Participation in CR in Vestfold was associated with higher levels of smoking cessation and medication adherence, and lower low-density lipoprotein cholesterol, but overall risk factor control is still deficient, underlining the need for improved understanding of barriers to optimal risk factor control.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Secondary prevention, cardiac rehabilitation, lifestyle changes, risk factor control, coronary heart disease patients, drug adherence, information
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-67962 (URN)10.1177/2047487317719355 (DOI)000408390900004 ()28664773 (PubMedID)
Available from: 2017-09-14 Created: 2017-09-14 Last updated: 2017-09-14Bibliographically approved
Theorell, T., Jood, K., Jarvholm, L. S., Vingard, E., Perk, J., Ostergren, P. O. & Hall, C. (2016). A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. European Journal of Public Health, 26(3), 470-477
Open this publication in new window or tab >>A systematic review of studies in the contributions of the work environment to ischaemic heart disease development
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2016 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 3, p. 470-477Article, review/survey (Refereed) Published
Abstract [en]

Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.

Place, publisher, year, edition, pages
Oxford University Press, 2016
National Category
Occupational Health and Environmental Health
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-69030 (URN)10.1093/eurpub/ckw025 (DOI)000377470800024 ()27032996 (PubMedID)
Available from: 2017-11-28 Created: 2017-11-28 Last updated: 2018-01-13Bibliographically approved
Good, E., Länne, T., Wilhelm, E., Perk, J., Jaarsma, T. & De Muinck, E. (2016). High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management. European Journal of Preventive Cardiology, 23(13), 1453-1460
Open this publication in new window or tab >>High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management
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2016 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 13, p. 1453-1460Article in journal (Refereed) Published
Abstract [en]

Background Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Design Cross-sectional retrospective study. Methods Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). Results A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. Conclusions The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.

Keywords
atherosclerosis, cardiovascular disease, cardiovascular risk management, High-grade carotid stenosis, secondary prevention
National Category
Cardiac and Cardiovascular Systems Nursing Surgery
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-56078 (URN)10.1177/2047487316632629 (DOI)000382655100013 ()26879568 (PubMedID)2-s2.0-84981543056 (Scopus ID)
Available from: 2016-09-16 Created: 2016-08-31 Last updated: 2017-11-21Bibliographically approved
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