EPCCS 2009

Summary of the presentations held during the Second Annual meeting of the EPCCS in Barcelona, Sept 3-4, 2009

Over 400 health care professionals registered for the 2nd Annual Meeting of the European Primary Care Cardiovascular Society. The meeting took the form of a “clinical masterclass’ with discussion on key areas of cardiovascular disease of importance to primary care.

It was a great success, with presentations from expert speakers, lively discussion, and well-attended sessions throughout the two days.

HYPERTENSION AND STROKE MASTERCLASS -EPCCS-09

Stroke risk in AF Assessing risk of stroke in patients with atrial fibrillation is essential so that appropriate thromboprophylaxis can be started. There are numerous schemes to stratify stroke risk but most have modest predictive value, said Professor Greg Lip (Birmingham, UK).

The well-known CHADS2 scheme has limitations: it does not include many risk factors and it classifies a large proportion of people as “moderate” risk. Nonetheless, it is simple to use and well validated.

ANTIPLATELET THERAPIES IN ACS - EPCCS 09

Discussing novel antiplatelet agents — prasugrel and ticagrelor — in acute coronary syndrome, Professor Steen Kristensen (Aarhus, Denmark) said it is now apparent that some patients have a low response to the widely used clopidogrel. This appears to be related to poor metabolism of the prodrug.

Two newer antiplatelet drugs, prasugrel and ticagrelor, act in way as clopidogrel as inhibitors of the platelet P2Y12 receptor.

Prasugrel (also a prodrug) is more potent than clopidogrel, and it has a more uniform response and faster onset. It is marketed for ACS patients undergoing percutaneous coronary intervention.
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HEART FAILURE MASTERCLASS - EPCCS 09

Diastolic heart failure Diastolic heart failure or, as it is now known, heart failure with normal ejection fraction (HFNEF) has become easier to diagnose but there is limited evidence on treatment, said Professor Martin Cowie (London, UK). In practice, the condition is treated very similarly to systolic heart failure.

Many patients with coronary heart disease, diabetes, hypertension or obesity will have a stiff heart and be breathless on exertion but have a normal ejection fraction.
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CARDIOVASCULAR BIOMARKERS - EPCCS 09

DVT D-dimer testing might be useful in primary care to help with diagnosis of deep vein thrombosis (DVT), said Professor David Fitzmaurice (Birmingham, UK).

D-dimer is a fibrin degradation product. Its presence in plasma reflects turnover of clot in the body and levels are raised in DVT. However, they are also raised in other conditions, and in old age. The test is therefore sensitive but not specific for DVT.

DIABETES MASTERCLASS: Joint session with Primary Care Diabetes Europe

Glucose control For patients with early type 2 diabetes, intensive glucose control to HbA1c levels of around 6.5% is probably useful. But after 5-10 years, control might be relaxed to around 7%.

That was the recommendation given by Dr Neil Munro (GP, Surrey, and Chelsea and Westminster Hospital, London, UK). He explained that when UKPDS was published in..
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REDUCING CV RISK

Lifestyle change Lifestyle change has probably contributed more than medical treatments to reduction in cardiovascular disease, said Professor Mike Kirby (London, UK). In industrialised countries it estimated that 50-60% of the reduction in death from cardiovascular disease has been from reduction in risk factors.

But there are specific areas of concern. “The increase in obesity and diabetes and lower physical activity in the population threatens to destroy some of the good work we have been doing.”