Asian-Pacific Collaboration on CHD Risk Factor Intervention - ASPAC

Description:

Epidemiology of CAD risk factors and practice patterns in Asian-Pacific region.

Hypothesis:

To determine and compare the rates of measurement of coronary risk factors, the levels of those risk factors once measured, and the actual clinical practice measures taken following hospital admission for myocardial infarction (MI) or unstable angina in 10 Asian countries.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 4,100

Primary Endpoints:

Coronary disease incidence and case fatality rates

Principal Findings:

Data collection focused on obesity, hypertension, diabetes, dyslipidemias, and smoking. Publicly presented preliminary data has focused on dyslipidemias.

Measurement rates of cholesterol after admission for CHD were variable (42-99%), with only about half of the CHD patients seen in 3 countries tested for cholesterol levels within 6 months of an acute coronary event. Based on the cholesterol levels reported, average levels of total cholesterol (TC) were similar to or even higher than many Western countries, with about 50% of patients showing elevated cholesterol levels (range: 29-77%).

The rate of hypercholesterolemia is extremely high in Singapore, affecting about 2 of every 3 patients; the rate is lowest in the Philippines and Thailand where the majority of patients presenting with CHD have normal cholesterol levels. Hypercholesterolemia was defined as either a past history specifically stated in the medical records, a TC of at least 5.5 mmol/L or 213 mg/dL, or the use of cholesterol-lowering medication at admission, discharge, or later.

When hypercholesterolemia was based not only on blood measurement but also on documented past history of dyslipidemia or use of cholesterol-lowering medication, prevalence was even greater, increasing to fully 4 of every 5 patients in Singapore and a surprising 58% of patients in Japan.

Formal dietary advice to modify cholesterol levels was not provided in most countries studied. Only Japan showed any significant use (18%) of dietary advice, with only 1 of more than 400 patients in Singapore showing documentation of having received such advice. In the majority of countries, only about one-third of patients with hypercholesterolemia receive lipid-lowering medication.

The value of aspirin in acute coronary artery disease is widely recognized, with the majority of countries treating >80% of CHD patients with aspirin or some other antiplatelet treatment during acute event admission.

Interpretation:

The ASPAC investigators seek to determine how clinical practices that address cardiac risk factors relate to local circumstances in the Asian-Pacific countries. Risk factor patterns appear to differ within this region. Progressive industrialization and Westerinzation of the Asian-Pacific region risks increasing the global burden of atherosclerotic disease. These fundamental outcome data will facilitate implementation of risk-reduction efforts in higher-risk patient populations.

References:

1. Circulation 1998;98(Suppl I):I-322 Preliminary results

Clinical Topics: Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Homozygous Familial Hypercholesterolemia, Hypertension, Smoking

Keywords: Coronary Artery Disease, Myocardial Infarction, Platelet Aggregation Inhibitors, Risk Factors, Obesity, Hypercholesterolemia, Hypertension, Diabetes Mellitus, Smoking


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