PERCEPTION OF CVD RISK FACTORS BY DIFFERENT STAKEHOLDERS - DOCTORS, MEDICAL STUDENTS, GENERAL PUBLIC, POLITICIANS, JOURNALISTS Professor ŽeljkoReiner,

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1 PERCEPTION OF CVD RISK FACTORS BY DIFFERENT STAKEHOLDERS - DOCTORS, MEDICAL STUDENTS, GENERAL PUBLIC, POLITICIANS, JOURNALISTS Professor ŽeljkoReiner, MD,PhD,FRCP(Lond),FESC,FACC University Hospital Center Zagreb, University of Zagreb, Zagreb School of Medicine, Croatia

2 CAUSES OF DEATH IN CROATIA IN 2008 Izvor podataka: Državni zavod za statistiku, Hrvatski zavod za javno zdravstvo

3 PERCRO Study - PERCEPTION OF CARDIOVASCULAR RISK FACTORS IN CROATIA GENERAL POPULATION A questionnaire with 25 multiple choice questions In 37 pharmacies covering the whole area of Croatia consecutively to all customers willing to answer 883 respondents (questionnaires finished) September 1 to November 30, 2007

4 PERCRO Study - PERCEPTION OF CARDIOVASCULAR RISK FACTORS IN CROATIA PHYSICIANS In Croatia physicians (1753 GPs and 927 specialists in GP/family medicine, 987 general internists, 203 cardiologists) randomly recruited using national physicians registry and professional societies directories 5 regions, all cardiologists, every third GP/FP, every fifth internist A questionnaire with 25 multiple choice questions 1382 physicians (930 GP/FP, 165 cardiologists, 213 internists) answered March 1 to June 30, 2008

5 PERCRO Study - PERCEPTION OF CARDIOVASCULAR RISK FACTORS IN CROATIA MEDICAL STUDENTS A questionnaire with 25 multiple choice questions 443 medical students at the beginning of the study and at the end of the study On the enrolment day and graduation day September 2008 School of Medicine, University of Zagreb

6 PERCRO Study - PERCEPTION OF CARDIOVASCULAR RISK FACTORS IN CROATIA MEMBERS OF PARLIAMENT 77 out of 141 members of the Croatian Parliament - Sabor One day during the Parliament session in the Houses of Parliament 2008 A questionnaire with 25 multiple choice questions

7 PERCRO Study - PERCEPTION OF CARDIOVASCULAR RISK FACTORS IN CROATIA JOURNALISTS A questionnaire with 25 multiple choice questions 129 journalists from daily press newspaper, TV, radio In the Croatian Press Association House One day in 2008

8 Age Groups Distribution (years) 46,9% 35,9% 31,5% 24,0% 26,2% 28,8% 27,1% 27,1% 22,8% 19,0% 23,3% 23,9% General Pupolation Journalists Politicians Doctors 16,3% 7,9% 1,6% 1,1% 0% 0% 0% 0% 5,4% 6,8% 8,7% 3,9% 9,6% 2,2% 0% 0% 0% 0% 0% 0% >85 Medical Students all belong to the age group

9 Groups by Gender General Population Journalists 47% 53% 44% 56% Medical Students Politicians 67,42% 32,58% 59,72% 40,28% Male Female

10 Knowledge of Blood Pressure General Population Journalists 13% 26% 74% 87% Know Their Blood Pressure Don't know/no Answer Medical Students Politicians 18% 82% 10% 90%

11 Knowledge of Cholesterol Levels General Population Journalists 58% 42% 57% 43% Know Their Level Don't Know Level/No Answer Medical Students Politicians 26% 21% 74% 79%

12 Awareness of Bad Cholesterol 83,5% 56,8% 54,3% General Population Journalists Medical Students Politicians 31,0% 14,7% 10,9% 9,9% 12,0% 5,3% 26,4% 27,3% 20,2% 14,1% 8,7% 7,8% 5,3% 5,3% 2,7% 2,0% 1,8% HDL Cholesterol LDL Cholesterol Triglycerides None of Mentioned No Answer/Invalid Answer

13 Awareness of Good Cholesterol 82,4% 62,3% Population Journalists Medical Students Politicians 45,0% 50,0% 23,9% 26,4% 26,0% 16,3% 12,0% 9,8% 5,2% 2,2% 3,1% 0,9% 1,3% 14,1% 9,3% 5,2% 2,5% 2,3% HDL Cholesterol LDL Cholesterol Triglycerides None of Mentioned No Answer/Invalid Answer

14 Fear of Listed Diseases 63,9% 40,0% 48,6% 42,9% General Population Journalists Medical Students Politicians 28,6% 14,3% 14,5% 18,6% 10,4% 13,5% 13,0% 5,1% 0% 21,6% 23,3% 16,5% 9,3% 7,0% 0,0% 2,0% 2,3% 0% 0,0% 0,2% 0,8% 1,1% 1,3% 1,8% Cancer Cerebrovascular disease AIDS Heart disease Liver disease Tuberculosis and pulmonary disease No Answer/ Don'tknow

15 Awareness of the Leading Cause of Death Traffic Accidents Cancer 6,2% 10,8% 6,2% 10,5% 10,6% 16,3% 16,3% 27,0% Politicians Medical Students Journalists Population Cerebrovascular Disease 5,4% 5,9% 5,4% 8,6% AIDS 0,0% 0,2% 0,0% 0,8% Heart Disease 36,1% 53,5% 53,5% 72,0% Liver Cirrhosis Tuberculosis/Pulmonary Disease Don't Know/No Answer 0,0% 0,2% 0,0% 0,3% 0,0% 0,0% 0,8% 0,2% 0,2% 17,7% 17,8% 16,4%

16 Total cholesterol p=0,764 Kruskal-Wallis test

17 Triglycerides p=0,767 Kruskal-Wallis test

18 HDL - cholesterol Population : Parliament p=0,540 Population : Journalists p=0,003 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

19 LDL - cholesterol Population : Parliament p=0,999 Population : Journalists p=0,027 Journalists : Parliament p=0,045 Mann-Whitney test with correction for multiple testing

20 hs-crp Population : Parliament p=0,999 Population : Journalists p=0,069 Journalists : Parliament p=0,042 Mann-Whitney test with correction for multiple testing

21 Glucose Population : Parliament p=0,999 Population : Journalists p=0,015 Journalists : Parliament p=0,100 Mann-Whitney test with correction for multiple testing

22 HbA1c Population : Parliament p=0,876 Population : Journalists p=0,003 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

23 Height Population : Parliament p=0,003 Population : Journalists p=0,390 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

24 Weight Population : Parliament p=0,003 Population : Journalists p=0,999 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

25 BMI Population : Parliament p=0,003 Population : Journalists p=0,681 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

26 Waist Population : Parliament p=0,003 Population : Journalists p=0,999 Journalists : Parliament p=0,003 Mann-Whitney test with correction for multiple testing

27 Smoking Habits 75% 79% 57% 52% General Population Journalists Medical Students 28% 30% Politicians 22% 18% 15% 18% 3% 3% Smoker Former smoker Non-smoker

28 GP informed about the CV risks High Cholesterol Levels 30,9% 44,1% High Blood Pressure 27,0% 42,6% Smoking 20,6% 22,0% Obesity/Overweight 14,7% 21,1% None 38,2% 52,8% Population Journalists

29 Doctors by Speciality 18,8% 3,0% 12,2% 68,9% Family Doctors Cardiologists Internists Neurologists

30 Following of CVD Prevention Guidelines by Speciality International Atherosclerosis Society guidelines 9,3% 18,4% 16,7% US Guidelines 1,9% 1,4% 1,4% Joint European guidelines from 2007 Joint European guidelines from ,3% 7,1% 3,8% 59,6% 59,1% 71,3% Cardiologists Internists Primary care Institution guidelines 0,9% 2,8% 1,4% Own judgment 7,4% 10,6% 17,5%

31 Guidelines usefulness Do not know guidelines 1,8% 1,2% 1,2% Not useful Fairly useful 0,5% 0,6% 0,3% 20,9% 15,4% 22,9% Cardiologists Internists Primary care Very useful 76,8% 82,7% 75,5%

32 Knowledge of Joint European guidelines recommendation for HDL-chol. in women < 1.2 mmol/l 3,8% 2,5% 6,3% > 1.2 mmol/l 59,2% 58,7% 69,7% < 1.0 mmol/l > 1.0 mmol/l 2,5% 7,0% 6,5% 23,6% 17,4% 21,0% Cardiologists Internists Primary care > 0.9 mmol/l 5,1% 3,0% 3,6% < 0.9 mmol/l 5,7% 0,5% 3,9%

33 Knowledge of Joint European CVD Prevention Guidelines recommendation for blood pressure in high risk patients 120/80 mmhg 38,2% 34,5% 50,5% 130/85 mmhg 39,7% 43,3% 48,5% Cardiologists Internists 150/90 mmhg 8,9% 17,8% 14,1% Primary care 140/90 mmhg 0,6% 2,9% 0,9%

34 Knowledge on optimal blood pressure in high risk patients 37,1% 42,1% 40,0% 45,2% Medical Students Doctors 15,7% 11,2% 6,3% 1,6% <150/90 <140/90 <130/85 <120/80

35 Knowledge of recommended HDLcholesterol in women (mmol/l) 60,2% 34,7% Medical Students Doctors 22,2% 21,1% 14,7% 3,7% 3,6% 3,9% 13,5% 5,9% 11,2% 5,3% <0,9 >0,9 >1,0 <1,0 >1,2 <1,2

36 Knowledge on recommended LDL-cholesterol in patients with diabetes (mmol/l) 56,1% 24,3% 20,5% 30,4% 30,0% 24,8% Medical Students Doctors 7,5% 6,4% <5 <4 <3 <2,5

37 Lowering cholesterol with diet 68,4% 54,5% Medical Student Doctors 26,7% 18,9% 11,9% 9,7% 5,0% 2,7% 1,9% 0,3% 2-3% 10-15% about 50% 50-70% up to 90%

38 Broj ispitanika (%) Do you Believe you Treat Well Your Patients with Hyperlipidemia? Sm atrate li da dobro liječite svoje bolesnike hipelipidem ijom Liječnici OM (N=556) Kardiolozi (N=134) da ne ne znam

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43 Thank you!