191 Summary 8 were more likely to present a higher number of risk factors (rate ratio 1.05, 95% CI 1.021.08). These results point out the intersection of inequalities in health: women with a lower educational level presented the highest burden of multiple risk factors, and sex differences were largest among participants with low educational level. Chapter 5 reports explores hypertension awareness, treatment and control in the 5802 patients with CHD and hypertension in the EUROASPIRE V Study, conducted in 27 countries part of the the European Society of cardiology. Hypertensive patients were identified based on their BP measurement result at the study interview, medication use, and information from medical records. Aware patients (38.9%), defined as being told and were aware of their latest blood pressure measurement result and target level, were generally older and had a worse risk factor profile, and were more likely to change health behaviors. Almost all patients were using at least one antihypertensive drug and 39.7% were controlled. Logistic regression showed that hypertension control was associated with younger age, higher education, and a more favorable risk factor profile. In Chapter 6, we present the main results of the SURF CHD II Study and assess health inequalities by educational level in secondary prevention. SURF CHD II, a simplified clinical audit, included 13884 CHD outpatients from 29 high-, upper middle-, and low middleincome countries, including areas often underrepresented in research. Recording of risk factor information was high for smoking (96.1%) and blood pressure (92.8%), but low for risk factors such as BMI (59.1%) and waist circumference (25.4%). Risk factor target attainment levels were poor, especially for weight-related factors (BMI 26.7%, waist circumference 24.4%) and blood lipids (LDL <1.8mmol/L 42.8%). Most patients were using recommended medications, but only half of the patients attended cardiac rehabilitation. Patients with higher education were generally more likely to meet risk factor targets and attend cardiac rehabilitation, revealing health inequalities in secondary prevention by educational level globally. Chapter 7 summarizes the main findings of this thesis and discusses the content, representativeness and quality of surveys in secondary prevention. We also evaluate the strengths and limitations of current surveys in these aspects, and propose approaches to increase the impact of surveys in secondary prevention policy and practice.
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