139 Cardiovascular risk factors by educational level in CHD patients: SURF CHD II 6 INTRODUCTION Coronary heart disease (CHD) is the leading cause of death and a major cause of disability worldwide. The Global Burden of Disease Study estimates that there were 9.14 million deaths and 197 million prevalent cases of CHD in 2019 occurring predominantly in low- and middle-income countries (LMIC) (1). Most of the burden of CHD is attributable to risk factors, many of which are potentially modifiable or controllable through lifestyle changes and medication use (1–3). People with established CHD are at very high cardiovascular risk (4). Therefore, risk factor control through lifestyle modification and medical therapy is fundamental to reduce risk of cardiovascular events and mortality. Clinical guidelines define targets for risk factor control in CHD patients, including smoking cessation, physical activity, weight and body composition, blood pressure, lipids, and glucose levels (Table 1) (4,5). There are several challenges in secondary prevention of CHD. Risk factor data is often not recorded in full, and thus relevant information for risk factor management may be unavailable in daily practice. In terms of control, large proportions of participants do not meet risk factor targets. The most recent EUROASPIRE survey (6) reported poor levels of target attainment, despite high rates of medication use. Research on the drivers of risk factor control in patients with CHD can provide a deeper understanding of the challenges to adequate secondary prevention. Socioeconomic circumstances, such as educational level, have an impact on risk factor control and medication use in the context of secondary prevention. Lower educational level has been linked to higher prevalence of risk factors, lower treatment levels and higher risk of future cardiovascular events (7,8). Such inequalities in secondary prevention have shown to be context-dependent and may vary in different regions (9). Risk factor Target Smoking No smoking or cessation Physical activity Moderately vigorous physical activity ≥30 minutes 3-5 times/week BMI <25 kg/m2 Waist circumference <94 cm in men (<90cm in South-East Asian men) and <80 cm in women Blood pressure <140/90 mmHg (<140/85 mmHg in diabetics) LDL <1.8mmol/L. Stricter target: <1.4mmol/L non-HDL cholesterol <2.2 mmol/L Triglycerides <1.7 mmol/L Hba1c (in diabetics) <7% Table 1: Definition of risk factor targets.
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