Guy De Backer

Ghent University, Gand, Flanders, Belgium

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Publications (192)759.99 Total impact

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    ABSTRACT: To compare gender-related lifestyle changes and risk factor management after hospitalisation for a coronary event or revascularisation intervention in Europe. The EUROASPIRE III survey was carried out in 22 European countries in 2006-2007. Consecutive patients having had a coronary event or revascularisation before the age of 80 were identified. A total of 8966 patients (25.3% women) were interviewed and underwent clinical and biochemical tests at least 6 months after hospital admission. Trends in cardiovascular risk management were assessed on the basis of the 1994-1995, 1999-2000 and 2006-2007 EUROASPIRE surveys. Female survey participants were generally older and had a lower educational level than male participants (p<0.0001). The prevalences of obesity (p<0.0001), high blood pressure (BP) (p=0.001), elevated low-density lipoprotein (LDL)-cholesterol (p<0.0001) and diabetes (p<0.0001) were significantly higher in women than in men, whereas current smoking (p<0.0001) was significantly more common in men. The use of antihypertensive and antidiabetic drugs (but not that of other drugs) was more common in women than in men. However, BP (p<0.0001), LDL-cholesterol (p<0.0001) and HbA1c (p<0.0001) targets were less often achieved in women than in men. Between 1994 and 2007, cholesterol control improved less in women than in men (interaction: p=0.009), whereas trends in BP control (p=0.32) and glycaemia (p=0.36) were similar for both genders. The EUROASPIRE III results show that despite similarities in medication exposure, women are less likely than men to achieve BP, LDL-cholesterol and HbA1c targets after a coronary event. This gap did not appear to narrow between 1994 and 2007.
    Heart (British Cardiac Society) 11/2010; 96(21):1744-9. · 5.01 Impact Factor
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    ABSTRACT: To determine whether the 2003 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been followed in general practice. Cross-sectional survey. The EUROASPIRE survey was carried out in 2006-2007 in 66 general practices in 12 European countries. Patients without a history of coronary or other atherosclerotic disease either started on antihypertensive and/or lipid-lowering and/or antidiabetes treatments were identified retrospectively, interviewed and examined at least 6 months after the start of medication. Four thousand, three hundred and sixty-six high-risk individuals (57.7% females) were interviewed (participation rate 76.7%). Overall, 16.9% smoked cigarettes, 43.5% had body mass index ≥30 kg/m, 70.8% had blood pressure ≥140/90 mmHg (≥130/80 in people with diabetes mellitus), 66.4% had total cholesterol ≥5.0 mmol/l (≥4.5 mmol/l in people with diabetes) and 30.2% reported a history of diabetes. The risk factor control was very poor, with only 26.3% of patients using antihypertensive medication achieving the blood pressure goal, 30.6% of patients on lipid-lowering medication achieving the total cholesterol goal and 39.9% of patients with self-reported diabetes having haemoglobin A1c ≤6.1%. The use of blood pressure-lowering medication in people with hypertension was: β-blockers 34.1%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers 60.8%, calcium channel blockers 26.3%, diuretics 36.9%. Statins were prescribed in 47.0% of people with hypercholesterolemia. About 22.0% of all patients were on aspirin or other antiplatelet medication. The EUROASPIRE III survey in general practice shows that the lifestyle of people being treated as high cardiovascular risk is a major cause of concern with persistent smoking and high prevalence of both obesity and central obesity. Blood pressure, lipid and glucose control are completely inadequate with most patients not achieving the targets defined in the prevention guidelines. Primary prevention needs a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by general practitioners, nurses and other allied health professionals, and a health care system which invests in prevention.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 10/2010; 17(5):530-40. · 2.51 Impact Factor
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    ABSTRACT: Several studies have reported increasing obesity rates in the general population. Using data from the EUROASPIRE III survey, we investigated as to what extent the obesity epidemic affects the high priority group of coronary heart disease patients. Data from 8924 patients, who had experienced a recent coronary acute event, from 22 countries in Europe participating in the EUROASPIRE III study were gathered in 2006-2007. Eight centres had also participated in the earlier two EUROASPIRE surveys carried out in 1994-1995 and 1999-2000. In these eight centres, obesity prevalence in coronary patients had increased from 25 to 38% during the past decade. The most recent survey shows that obesity is more prevalent in women (45 vs. 32% in men) and is a major health problem across all the 22 countries. Only 18% of all the patients were found to reach a body mass index below 25 kg/m whereas 53% were diagnosed with central obesity. Since their hospital discharge, only half of the obese patients reported to have followed the dietary recommendations and 48% reported engagement in more physical activity. Only 13% of the patients who were overweight at the time of the coronary event reached the target of >or=5% weight loss whereas 21% of them presented with a weight gain of 5% or more. The prevalence of obesity is still increasing and reaching epidemic proportions in the high priority group of coronary patients all over Europe. Patients' awareness and current management of obesity seems inadequate. More intensive programs focusing on diet and especially physical activity are urgently required.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 08/2010; 17(4):447-54. · 2.51 Impact Factor
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    ABSTRACT: The aim was to examine the perception of work stressors in relation to ambulatory measures of heart rate variability (HRV). Results are based on a sample of 653 healthy male workers aged 40-55 from the Belgian Physical Fitness Study conducted in 1976-1978. Data were collected by means of self-administered questionnaires and bio-clinical examinations. An index of physical and psychosocial work stressors containing five items was constructed based on the job stress questionnaire. Data on HRV were collected by means of 24-h ambulatory ECG recordings on a working day. Both time and frequency domain measures of HRV were calculated. Associations between work stressors and HRV measures were assessed by means of correlations, multiple linear regression analysis and analysis of (co)variance. The work stressor index was significantly associated with lower pNN50 (the percentage of differences between adjacent normal RR intervals > 50 ms), lower high frequency power and a higher ratio of low frequency over high frequency power. Very similar results were obtained after adjusting for age, language, occupation, smoking, body mass index, total cholesterol, systolic blood pressure and leisure time physical activity. No significant associations were found with SDNN (the standard deviation of all normal RR intervals) and low frequency power. The perception of work stressors was related to reduced parasympathetic activity in a sample of 653 healthy male workers. These findings support the idea that particularly the parasympathetic component of the autonomic nervous system is related to work stress.
    International Archives of Occupational and Environmental Health 05/2010; 84(2):185-91. · 2.10 Impact Factor
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    ABSTRACT: The aim of this study was to determine the prevalence of dietary supplement use among Flemish preschoolers and to investigate associations between dietary supplement use and socio-economic variables of the parents. Parentally reported 3-day estimated dietary records (n=696) were used to calculate mean daily nutrient intakes, using Software for Intake Distribution Estimation (Cside). Socio-demographic information and frequency of dietary supplement use were collected via parental questionnaires, including a food frequency questionnaire (FFQ) (n=1847). The results from the FFQ revealed that more than 30% of the children used dietary supplements in the past month. Children of more highly educated parents and children of non-smokers were significantly more likely to use supplements than their counterparts. The types most frequently used were multi-vitamin/mineral supplements. Except for vitamin D, mean dietary intakes derived from foods alone was higher than the minimum recommendations for both supplement and non-supplement users. The youngest group of supplement users even exceeded the tolerable upper intake level for zinc (7 mg). However, for vitamin D, dietary supplements could help meet dietary recommendations for this micronutrient. In conclusion, the results indicated that dietary supplement use by healthy children who typically achieve their micronutrient requirements by foods alone could cause excessive intakes. Future studies should investigate potential harms and benefits of dietary supplementation use among preschoolers.
    Appetite 04/2010; 54(2):340-5. · 2.54 Impact Factor
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    ABSTRACT: The diet quality index (DQI) for preschool children is a new index developed to reflect compliance with four main food-based dietary guidelines for preschool children in Flanders. The present study investigates: (1) the validity of this index by comparing DQI scores for preschool children with nutrient intakes, both of which were derived from 3 d estimated diet records; (2) the reproducibility of the DQI for preschoolers based on a parentally reported forty-seven-item FFQ DQI, which was repeated after 5 weeks; (3) the relative validity of the FFQ DQI with 3 d record DQI scores as reference. The study sample included 510 and 58 preschoolers (2.5-6.5 years) for validity and reproducibility analyses, respectively. Increasing 3 d record DQI scores were associated with decreasing consumption of added sugars, and increasing intakes of fibre, water, Ca and many micronutrients. Mean FFQ DQI test-retest scores were not significantly different: 72 (sd 11) v. 71 (sd 10) (P = 0.218) out of a maximum of 100. Mean 3 d record DQI score (66 (sd 10)) was significantly lower than mean FFQ DQI (71 (sd 10); P < 0.001). The reproducibility correlation was 0.88. Pearsons correlation (adjusted for within-person variability) between FFQ and 3 d record DQI scores was 0.82. Cross-classification analysis of the FFQ and 3 d record DQI classified 60 % of the subjects in the same category and 3 % in extreme tertiles. Cross-classification of repeated administrations classified 62 % of the subjects in the same category and 3 % in extreme categories. The FFQ-based DQI approach compared well with the 3 d record approach, and it can be used to determine diet quality among preschoolers.
    The British journal of nutrition 03/2010; 104(1):135-44. · 3.45 Impact Factor
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    Guy De Backer
    Heart (British Cardiac Society) 03/2010; 96(6):477-82. · 5.01 Impact Factor
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    ABSTRACT: Objectives: Noninvasive estimation of central blood pressure (BP) from radial artery pressure waveforms is increasingly applied. We investigated the impact of radial artery waveform calibration on central BP assessment and calculated pressure amplification, with focus on the one-third rule used to estimate mean arterial BP (MAP). Methods: Pressure waveforms were noninvasively measured at the radial and carotid arteries in 1873 individuals (age 45.8±6.1 years). Radial and carotid artery waveforms were calibrated using brachial artery DBP and SBP, MAP estimated with the one-third rule and MAP estimated as brachial DBP along with 40% of brachial artery pulse pressure. Results: Central SBP obtained via a transfer function was 123.5 ± 15.7, 117.8 ± 14.2 and 126.0 ± 15.4 mmHg (mean ± SD) following above-mentioned three calibration schemes, respectively. Using the same calibration schemes, carotid artery SBP was 131.4 ± 15.2, 118.4 ± 14.4 and 126.8 ± 15.7 mmHg, respectively. Central-to-brachial amplification was 13.0 ± 3.6 mmHg using second method as compared with 4.6 ± 3.8 mmHg with third method. Brachial-to-radial amplification was actually negative (−6.3 ± 4.5 mmHg) using second method, whereas 3.4 ± 5.5 mmHg was found with third method. Conclusion: Both carotid artery SBP and central SBP obtained via a transfer function are highly sensitive to the calibration of the respective carotid artery and radial artery pressure waveforms. Our data suggest that the one-third rule to calculate MAP from brachial cuff BP should be avoided, especially when used to calibrate radial artery pressure waveforms for subsequent application of a pressure transfer function. Until more precise estimation methods become available, it is advisable to use 40% of brachial pulse pressure instead of 33% to assess MAP.
    Journal of Hypertension 01/2010; 28(2):300–305. · 4.22 Impact Factor
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    ABSTRACT: In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. We identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (OR(adj) 23.0; 95% CI [20.9;25.2]), and five-year age groups OR(adj) 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter-type of hospital differences {(OR(comunity vs tertiary hospitals)1.36; 95% CI [1.34;1.39]) and (OR(intermediary vs tertiary hospitals)1.36; 95% CI [1.34;1.39])}, and nonconformities to guidelines for treatment were observed. Despite established data quality shortcomings, the magnitude of the observed differences and the nonconformities constitute leads to quality improvement. However, to measure progress, ways to improve and routinely monitor data quality should be developed.
    BMC Health Services Research 01/2010; 10:334. · 1.77 Impact Factor
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    ABSTRACT: The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. ( number, NCT00882336).
    BMC Public Health 01/2010; 10:382. · 2.08 Impact Factor
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    ABSTRACT: Development of a validated risk prediction model for future cardiovascular disease (CVD) in Australians is a high priority for cardiovascular health strategies. Recalibration of the SCORE (Systematic COronary Risk Evaluation) risk chart based on Australian national mortality data and average major CVD risk factor levels. Australian national mortality data (2003-2005) were used to estimate 10-year cumulative CVD mortality rates for people aged 40-74 years. Average age-specific and sex-specific levels of systolic blood pressure, total cholesterol and prevalence of current smoking were generated from data obtained in eight Australian large-scale population-based surveys undertaken from the late 1980s. The SCORE risk chart was then recalibrated by applying hazard ratios for 10-year CVD mortality obtained in the SCORE project. Discrimination and calibration of the recalibrated model was evaluated and compared with that of the original SCORE and Framingham equations in the Blue Mountains Eye Study in Australia using Harrell's c and Hosmer-Lemeshow chi statistics, respectively. An Australian risk prediction chart for CVD mortality was derived. Among 1998 Blue Mountains Eye Study participants aged 49-74 years with neither CVD nor diabetes at baseline, the Harrell's c statistics for the Australian risk prediction chart for CVD mortality were 0.76 (95% confidence interval: 0.69-0.84) and 0.71 (confidence interval: 0.62-0.80) in men and women, respectively. The corresponding Hosmer-Lemeshow chi statistics, the measure of calibration, were 2.32 (P = 0.68) and 7.43 (P = 0.11), which were superior to both the SCORE and Framingham equations. This new tool provides a valid and reliable method to predict risk of CVD mortality in the general Australian population.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 10/2009; 16(5):562-70. · 2.51 Impact Factor
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    ABSTRACT: To examine the relation between work-family conflict and sickness absence. The BELSTRESS III study comprised 2983 middle-aged workers. Strain-based work-home interference (WHI) and home-work interference (HWI) were assessed by means of self-administered questionnaires. Prospective data of registered sickness absence during 12-months follow-up were collected. Multiple logistic regression analysis was conducted. HWI was positively and significantly related to high sickness absence duration (at least 10 sick leave days) and high sickness absence frequency (at least 3 sick leave episodes) in men and women, also after adjustments were made for sociodemographic variables, health indicators, and environmental psychosocial factors. In multivariate analysis, no association between WHI and sickness absence was found. HWI was positively and significantly related to high sickness absence duration and frequency during 12-months follow-up in male and female workers.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 09/2009; 51(8):879-86. · 1.88 Impact Factor
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    Acta cardiologica 09/2009; 64(4):537-9. · 0.61 Impact Factor
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    ABSTRACT: Peripheral blood leucocyte (PBL) telomere length (TL) is a systemic ageing biomarker and has been proposed to be an independent predictor of cardiovascular disease (CVD). We aimed at providing an explanation for this association by the evaluation of the biomarker value of PBL-TL in preclinical atherosclerosis. Peripheral blood leucocyte telomere length was assessed by telomere restriction fragment analysis in 2509 volunteers free from established CVD, aged approximately 35-55 years old, from the Asklepios Study cohort. Intima-media thickness (IMT) and plaque presence were determined by ultrasonography in both left and right carotid and femoral arteries. Peripheral blood leucocyte telomere length was not a significant independent determinant of IMT (P > 0.3) or plaque presence (P > 0.05), in either artery or either sex. In women but not in men, PBL-TL was a weak determinant of combined (carotid or femoral) plaque presence, adjusted for other risk factors (women: P = 0.03, men: P > 0.4). However, even in women presenting plaques, PBL-TL was still longer than in men. Since systemic TL is not a substantial underlying determinant of preclinical atherosclerosis, the association between CVD and TL cannot be explained by the fact that subjects with shorter inherited TL are predisposed to atherosclerosis.
    European Heart Journal 08/2009; 30(24):3074-81. · 14.10 Impact Factor
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    ABSTRACT: Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation. The study consisted of 57,302 men and 47,659 women. Cox proportional hazards method was used to derive the function including HDL-C and an identical function without HDL-C for comparison. Risk charts were developed to illustrate the results. Inclusion of HDL-C resulted in a modest but statistically significant improvement in risk estimation, based on the area under receiver operating characteristic curve (AUROC); 0.814 versus 0.808, P value less than 0.0001, for the functions with and without HDL-C, respectively. Addition of HDL-C also resulted in a significant and important improvement in risk estimation as measured by net reclassification index, which is highly clinically relevant. Improvement in risk estimation was greatest in women from high-risk countries, in terms of both AUROC and net reclassification index. For the general population, the inclusion of HDL-C in risk estimation results in only a modest improvement in overall risk estimation based on AUROC. However, when using the more clinically that examines reclassification of individuals, clinically useful improvements occur. Inclusion of HDL may be particularly useful in women from high-risk countries and individuals with unusually high or low HDL-C levels. Addition of HDL-C is particularly applicable to electronic, interactive risk estimation systems such as HeartScore.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 07/2009; 16(3):304-14. · 2.51 Impact Factor
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    ABSTRACT: Central-to-peripheral amplification of the pressure pulse leads to discrepancies between central and brachial blood pressures. This amplification depends on an individual's hemodynamic and (patho)physiological characteristics. The aim of this study was to assess the magnitude and correlates of central-to-peripheral amplification in the upper limb in a healthy, middle-aged population (the Asklepios Study). Carotid, brachial, and radial pressure waveforms were acquired noninvasively using applanation tonometry in 1873 subjects (895 women) aged 35 to 55 years. Carotid, brachial, and radial pulse pressures were calculated, as well as the absolute and relative (with carotid pulse pressure as reference) amplifications. With subjects classified per semidecade of age, carotid-to-radial amplification varied from approximately 25% in the youngest men to 8% in the oldest women. Amplification was higher in men (20+/-14%) than in women (13+/-12%; P<0.001) and decreased with age (P<0.001) in both. Amplification over the brachial-to-radial path contributed substantially to the total amplification. In univariate analysis, the strongest correlation was found with the carotid augmentation index (-0.51 in women; -0.47 in men; both P<0.001). In a multiple linear regression model with carotid-to-radial amplification as the dependent variable, carotid augmentation index, total arterial compliance, and heart rate were identified as the 3 major determinants of upper limb pressure amplification (R2=0.36). We conclude that, in healthy middle-aged subjects, the central-to-radial amplification of the pressure pulse is substantial. Amplification is higher in men than in women, decreases with age, and is primarily associated with the carotid augmentation index.
    Hypertension 06/2009; 54(2):414-20. · 6.87 Impact Factor
  • Dirk De Bacquer, Guy De Backer
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    ABSTRACT: The identification of persons at high cardiovascular risk is of primary importance in the context of cardiovascular prevention. Accuracy and precision of risk assessment are essential properties. We developed a calibrated SCORE risk chart (Systematic COronary Risk Evaluation) for calculating the absolute 10-year probability of developing a fatal cardiovascular event, adapted to national mortality statistics and risk factor distributions in Belgium and critically evaluated its predictive accuracy. Our SCORE Belgium risk chart was validated using data from 6212 non-diabetic men and women free of CHD participating in a prospective cohort study carried out in the eighties (Belgian Interuniversity Research on Nutrition and Health). Agreement between numbers of predicted and observed CVD deaths across the entire spread of risk was studied using chi-square and Hosmer-Lemeshow statistics. Discriminatory power of risk estimates was evaluated according to Harrell's c-statistic. During the period of 10 years, 274 CVD deaths were observed while the recalibrated risk chart predicted 263 events. The SCORE Belgium risk chart showed very good accuracy over the complete range of predicted risk (Hosmer-Lemeshow: P=0.14). ROC analysis revealed excellent discriminatory power in labelling future cases of fatal cardiovascular disease with a c-statistic of 0.86. The 5% threshold for the probability of 10-year cardiovascular death yielded an optimal balance of sensitivity and specificity. The SCORE Belgium risk chart proves to be well suited as an accurate and precise estimation tool for the assessment of cardiovascular risk in Belgium.
    International journal of cardiology 05/2009; 143(3):385-90. · 6.18 Impact Factor
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    ABSTRACT: The aim of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey was to determine whether the Joint European Societies' guidelines on cardiovascular prevention are being followed in everyday clinical practice and to describe the lifestyle, risk factor and therapeutic management in patients with coronary heart disease (CHD) in Europe. The EUROASPIRE III survey was carried out in 2006-2007 in 76 centres from selected geographical areas in 22 countries in Europe. Consecutive patients, with a clinical diagnosis of CHD, were identified retrospectively and then followed up, interviewed and examined at least 6 months after their coronary event. Thirteen thousand nine hundred and thirty-five medical records (27% women) were reviewed and 8966 patients were interviewed. At interview, 17% of patients smoked cigarettes, 35% were obese and 53% centrally obese, 56% had a blood pressure >or=140/90 mmHg (>or=130/80 in people with diabetes mellitus), 51% had a serum total cholesterol >or=4.5 mmol/l and 25% reported a history of diabetes of whom 10% had a fasting plasma glucose less than 6.1 mmol/l and 35% a glycated haemoglobin A1c less than 6.5%. The use of cardioprotective medication was: antiplatelets 91%; beta-blockers 80%; angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 71%; calcium channel blockers 25% and statins 78%. The EUROASPIRE III survey shows that large proportions of coronary patients do not achieve the lifestyle, risk factor and therapeutic targets for cardiovascular disease prevention. Wide variations in risk factor prevalences and the use of cardioprotective drug therapies exist between countries. There is still considerable potential throughout Europe to raise standards of preventive care in order to reduce the risk of recurrent disease and death in patients with CHD.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 04/2009; 16(2):121-37. · 2.51 Impact Factor
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    ABSTRACT: The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice. EUROASPIRE I, II, and III were designed as cross-sectional studies and included the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, and Slovenia. Consecutive patients (men and women </=70 years) were identified after coronary artery bypass graft or percutaneous coronary intervention, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. 3180 patients were interviewed in the first survey, 2975 in the second, and 2392 in the third. Overall, the proportion of patients who smoke has remained nearly the same (20.3% in EUROASPIRE I, 21.2% in II, and 18.2% in III; comparison of all surveys p=0.64), but the proportion of women smokers aged less than 50 years has increased. The frequency of obesity (body-mass index >/=30 kg/m(2)) increased from 25.0% in EUROASPIRE I, to 32.6% in II, and 38.0% in III (p=0.0006). The proportion of patients with raised blood pressure (>/=140/90 mm Hg in patients without diabetes or >/=130/80 mm Hg in patients with diabetes) was similar (58.1% in EUROASPIRE I, 58.3% in II, and 60.9% in III; p=0.49), whereas the proportion with raised total cholesterol (>/=4.5 mmol/L) decreased, from 94.5% in EUROASPIRE I to 76.7% in II, and 46.2% in III (p<0.0001). The frequency of self-reported diabetes mellitus increased, from 17.4%, to 20.1%, and 28.0% (p=0.004). These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease. Despite a substantial increase in antihypertensive and lipid-lowering drugs, blood pressure management remained unchanged, and almost half of all patients remain above the recommended lipid targets. To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention.
    The Lancet 04/2009; 373(9667):929-40. · 39.06 Impact Factor
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    ABSTRACT: The aims of this study were to assess the relative validity and reproducibility of a semi-quantitative food-frequency questionnaire (FFQ) applied in a large region-wide survey among 2.5-6.5 year-old children for estimating food group intakes. Parents/guardians were used as a proxy. Estimated diet records (3d) were used as reference method and reproducibility was measured by repeated FFQ administrations five weeks apart. In total 650 children were included in the validity analyses and 124 in the reproducibility analyses. Comparing median FFQ1 to FFQ2 intakes, almost all evaluated food groups showed median differences within a range of +/- 15%. However, for median vegetables, fruit and cheese intake, FFQ1 was > 20% higher than FFQ2. For most foods a moderate correlation (0.5-0.7) was obtained between FFQ1 and FFQ2. For cheese, sugared drinks and fruit juice intakes correlations were even > 0.7. For median differences between the 3d EDR and the FFQ, six food groups (potatoes & grains; vegetables Fruit; cheese; meat, game, poultry and fish; and sugared drinks) gave a difference > 20%. The largest corrected correlations (>0.6) were found for the intake of potatoes and grains, fruit, milk products, cheese, sugared drinks, and fruit juice, while the lowest correlations (<0.4) for bread and meat products. The proportion of subjects classified within one quartile (in the same/adjacent category) by FFQ and EDR ranged from 67% (for meat products) to 88% (for fruit juice). Extreme misclassification into the opposite quartiles was for all food groups < 10%. The results indicate that our newly developed FFQ gives reproducible estimates of food group intake. Overall, moderate levels of relative validity were observed for estimates of food group intake.
    International Journal of Environmental Research and Public Health 01/2009; 6(1):382-99. · 2.00 Impact Factor

Publication Stats

12k Citations
759.99 Total Impact Points


  • 1998–2014
    • Ghent University
      • • Department of Public Health
      • • Faculty of Medicine and Health Sciences
      • • Department of Molecular Biotechnology
      • • Cardiology
      Gand, Flanders, Belgium
  • 2011–2013
    • University of Zagreb
      • • Department of Internal Medicine
      • • School of Medicine (MEF)
      Zagrabia, Grad Zagreb, Croatia
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, MD, United States
    • Universidad Autónoma de Madrid
      • Departamento de Medicina
      Madrid, Madrid, Spain
  • 2001–2013
    • Universitair Ziekenhuis Ghent
      • • Department of Cardiology
      • • Department of Nuclear Medicine
      Gand, Flanders, Belgium
  • 2012
    • European Society of Cardiology
      Provence-Alpes-Côte d'Azur, France
    • Linnaeus University
      • Department of Health and Caring Sciences
      Kalmar, Kalmar, Sweden
  • 2009–2012
    • The Adelaide and Meath Hospital Ireland
      Dublin, Leinster, Ireland
    • Imperial College London
      • Cardiovascular Sciences
      London, ENG, United Kingdom
    • Monash University (Australia)
      • Department of Epidemiology and Preventive Medicine
      Melbourne, Victoria, Australia
  • 2007–2011
    • University of Milan
      • Department of Pharmacological Sciences
      Milano, Lombardy, Italy
  • 2006
    • Free University of Brussels
      Bruxelles, Brussels Capital Region, Belgium
  • 2003
    • Arkansas Heart Hospital
      Little Rock, Arkansas, United States