Potential for cholesterol lowering in secondary prevention of coronary heart disease in Europe: findings from EUROASPIRE study

We have examined the potential for cholesterol lowering in secondary prevention of coronary heart disease based on data from the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) study carried out in 1995–1996 in nine European centres (Czech Republic, Finland, France, Germany, Hungary, Italy, The Netherlands, Slovenia and Spain). Consecutive patients aged ≤70 years in four diagnostic categories — coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without infarction — were identified from hospital records and invited for an interview and risk factor assessment at least 6 months after hospital admission. Plasma lipid measurements were carried out in a central laboratory. Combining patients from all centres and diagnostic categories (n=2749) the medians (interquartile ranges) for plasma lipids were: total cholesterol 5.36 (4.76–6.03) mmol/l, high density lipoprotein (HDL) cholesterol 1.19 (1.01–1.42) mmol/l, triglycerides 1.55 (1.15–2.24) mmol/l, and low density lipoprotein (LDL) cholesterol 3.32 (2.76–3.91) mmol/l. Only 33% of the patients received lipid-lowering drugs. If the therapeutic goal given in the 1998 European recommendations, total cholesterol <5.0 mmol/l, were applied, 67% of these patients would have needed an intensified cholesterol-lowering action, and with an even stricter goal, total cholesterol <4.5 mmol/l, this proportion would have been as high as 84%.