Background — The EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease, identified after coronary artery bypass graft, percutaneous coronary intervention or myocardial infarction, with time trends in preventive cardiology over more than a decade. Aim — The aim of this study was to test the implementation of European recommendations for cardiac rehabilitation and secondary risk prevention programmes in the population of coronary heart disease patients from Serbia. Subjects and methods — A total of 665 consecutive coronary heart disease patients (432 men, 233 women, aged 59.43 ± 11.62 years), admitted for specialized cardiovascular rehabilitation, interviewed and examined in relation to the presence of coronary risk factors and administration of secondary prevention measures, were enrolled in the study. Results — High rates of smoking (27.67%), central obesity (58.05%), physical inactivity (61.50%) and adverse dietary habits (61.50%) were observed, as well as low frequency of patients who have reached recommended targets for waist circumference (41.95%), total cholesterol (40%), LDLcholesterol (39.25%), HDL-cholesterol (59.69%) and triglycerides (59.25%), while systolic (82.26%) and diastolic blood pressures (95.49%) were well regulated. A significantly lower rate of achieved therapeutic targets, despite widely used cardioprotective drugs, was observed in diabetic patients and patients with the metabolic syndrome. Conclusion — The results have shown a low proportion of coronary heart disease patients, especially with diabetes mellitus and metabolic syndrome, who reached the recommended therapeutic targets for cardiometabolic risk profile parameters, in spite of widely used cardioprotective drugs, and therefore clearly demonstrated the compelling need for more effective lifestyle management in the secondary prevention of coronary heart disease.

BACKGROUND The EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease, identified after coronary artery bypass graft, percutaneous coronary intervention or myocardial infarction, with time trends in preventive cardiology over more than a decade. AIM The aim of this study was to test the implementation of European recommendations for cardiac rehabilitation and secondary risk prevention programmes in the population of coronary heart disease patients from Serbia. SUBJECTS AND METHODS A total of 665 consecutive coronary heart disease patients (432 men, 233 women, aged 59.43 +/- 11.62 years), admitted for specialized cardiovascular rehabilitation, interviewed and examined in relation to the presence of coronary risk factors and administration of secondary prevention measures, were enrolled in the study. RESULTS High rates of smoking (27.67%), central obesity (58.05%), physical inactivity (61.50%) and adverse dietary habits (61.50%) were observed, as well as low frequency of patients who have reached recommended targets for waist circumference (41.95%), total cholesterol (40%), LDL-cholesterol (39.25%), HDL-cholesterol (59.69%) and triglycerides (59.25%), while systolic (82.26%) and diastolic blood pressures (95.49%) were well regulated. A significantly lower rate of achieved therapeutic targets, despite widely used cardioprotective drugs, was observed in diabetic patients and patients with the metabolic syndrome. CONCLUSION The results have shown a low proportion of coronary heart disease patients, especially with diabetes mellitus and metabolic syndrome, who reached the recommended therapeutic targets for cardiometabolic risk profile parameters, in spite of widely used cardioprotective drugs, and therefore clearly demonstrated the compelling need for more effective lifestyle management in the secondary prevention of coronary heart disease.

Introduction European treatment guidelines in persons with known coronary heart disease (CHD) focus on adherence to antiplatelet therapy, β-blockers, ACE/ARBs, and lipid-lowering agents, with goals for blood pressure (BP) of < 140/90 mm Hg and LDL cholesterol of < 3.0 mmol/l. Data on adherence to these measures in Eastern Europe are limited. Material and methods The Third Republic of Srpska, Bosnia and Herzegovina, Coronary Prevention Study (ROSCOPS III) was conducted in 2005–2006 at 10 primary heath care centres in 601 patients (36% female, mean age 55 years) with CHD including acute myocardial infarction or ischaemia, coronary artery bypass graft, or angioplasty who were examined and interviewed at least 6 months after the event. We examined the proportion of subjects on recommended treatments and at goal for BP, LDL-C, and non-smoking. Results The proportion of subjects on recommended treatments included 61% for β-blockers, 79% for ACE/ARBs, 63% for lipid-lowering agents and 74% for antiplatelet therapy. Only 30% of subjects were on all four of these treatments. 59% of subjects had BP at goal of < 140/90 mm Hg and 33% were controlled to < 130/80 mm Hg, 41% for LDL-C, and 88% were non-smokers. Improvements were seen in lipid-lowering and ACE/ARB drug use and non-smoking status from an earlier survey (ROSCOPS II) in 2002–2003. Conclusions Our data show, despite improvement over recent years, that many persons with CHD in the Republic of Srpska, Bosnia and Herzegovina are neither on recommended treatments nor at target for BP and/or LDL-C. Improved efforts targeted at both physicians and patients to address these issues are needed.

Patients who have survived myocardial infarction (MI), compared to the general population, have an increased risk of reinfarction, myocardial revascularization, and death. In this study we investigated the prognostic significance of the predictors of the risk for adverse coronary events in 118 patients, both male and female, with a confirmed diagnosis of MI in the last 3 years. The predictors of reinfarction, revascularization and death in patients who survived MI were: poor adherence to hypolipemics (hazard ratio [HR] 3.06, p=0.006), physical inactivity (HR 2.22, p=0.056), the number of variable risk factors (HR 1.29, p=0.025), and age (HR 1.06, p=0.007). After the inclusion of the invariable risk factors in the model of multivariant analysis, the following factors were singled out as significant predictors of the risk: gender (HR 3.86, p=0.0015), physical inactivity (HR 2.38, p=0.007), change in the level of triglycerides (HR 1.49, p=0.040), change in the number of variable risk factors (HR 1.41, p=0.0007), and age (HR 1.05, p=0.009). A 3-year follow-up of the patients who survived the first MI and who were enrolled in this study of secondary prevention demonstrated that physical inactivity, the number of variable risk factors and age significantly contributed to an increased risk of reinfarction, revascularization, and death.

Cardiovascular diseases are still the major cause of death, morbidity, mortality and loss of quality of life in European countries and worldwide. In Bosnia and Herzegovina we have burden of cardiovascular diseases with higher rate of morbidity and mortality than in the countries of EU zone or broader Europe. The cause of mortality is in close relation to multiple risk factors but also with specific conditions in our country; post war situation, transition and overall economic position. The main mission of European Society of Cardiology is to improve quality of life in the European population by reducing the impact of cardiovascular diseases. HeartScore web based program and PS Standalone program are introduce to assesses the overall risk of cardiovascular death for a period of 10 years, based on variables such as age, sex, smoking, systolic blood pressure and cholesterol levels in the blood, or total cholesterol/HDL ratio. Standalone PS HeartScore is practical to use, requires no permanent internet connection, the system offers its own database for each patient and the print version of the guidelines to reduce risk factors, based on evidence based medicine Program is tailored to patients, the system provides a graphical representation of the absolute risk of CVD, a version for our country is developed on the principle of high-risk populations and is available in the languages of the peoples of Bosnia and Herzegovina. Program is available for all types of medical practice which is equipped with computers, the laptop, and suitable for community nursing service as well.

In Bosnia and Herzegovina we have burden of cardiovascular diseases (CVD) with higher rate of morbidity and mortality than in the countries of EU zone or broader Europe and CVD are still the major cause of death, morbidity, mortality and loss of quality of life. Burden of CVD is in close relation to multiple risk factors but also with specific conditions in our country; post war situation, transition and overall economic position. The main mission of European Society of Cardiology is to improve quality of life in the European population by reducing the impact of cardiovascular diseases. HeartScore web based program is introduced to estimate the overall risk of cardiovascular death for a period of 10 years, based on 5 variables: age, sex, smoking, systolic blood pressure and cholesterol level or total cholesterol/ HDL ratio. This is of particular importance in predicting cardiovascular outcomes where misjudgments may have fatal consequences. Program is practical to use, takes account of the multifactorial nature of CVD, estimates risk of all atherosclerotic CVD, not just coronary heart disease, shows how risk increase with age, allows flexibility in management – if an ideal risk factor level cannot be achieved. The program offers its own database for each patient and also printing advices for reducing risk factors. HeartScore is tailored to patients, the system provides a graphical representation of the absolute risk of CVD. Version for our country is developed on the principle of high-risk populations and is available in the languages of the peoples of Bosnia and Herzegovina. Program is available for all types of medical practice which is equipped with computers, the laptops, and suitable for community nursing service as well.