Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study

Abstract

AimsMost studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk.Methods and resultsThis study was conducted with 7641 outpatients aged ≥50 years, free of clinical CVD and with at least one major CVD risk factor, selected from 12 European countries in 2009. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Cholesterol fractions and glycated haemoglobin (HbA1c) were measured in a central laboratory. Cardiovascular disease risk was estimated with the SCORE equation. Patients' mean age was 63 years (48% men), and 40.1% had a high CVD risk. Among treated hypertensives (94.2%), only 38.8% achieved the blood pressure target of <140/90 mmHg [between-country range (BCR): 32.1–47.5%]. Among treated dyslipidaemic patients (74.4%), 41.2% attained both the total- and LDL-cholesterol target of <5 and <3 mmol/L, respectively (BCR: 24.3–68.4%). Among treated type 2 diabetic patients (87.2%), 36.7% achieved the <6.5% HbA1c target (BCR: 23.4–48.4%). Among obese patients on non-pharmacological treatment (92.2%), 24.7% reached the body mass index target of <30 kg/m2 (BCR: 12.7–37.1%). About one-third of controlled patients on treatment were still at high remaining CVD risk. Although most patients were advised to reduce excess weight and to follow a low-calorie diet, less than half received written recommendations.ConclusionsIn Europe, a large proportion of patients in primary prevention have CVD risk factors that remain uncontrolled, and lifestyle counselling is not well implemented; moreover, there is substantial between-country variation, which indicates additional room for improvement. Raised residual CVD risk is relatively frequent among patients despite control of their primary risk factors and should be addressed.

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

“…Arterial hypertension affects up to 30% of the Italian population aged 35-74 years (17) and represents the single most important contributor to the global burden of disease and mortality (18). Despite this, only a minority of hypertensive patients attain optimal blood pressure control (19). This is due in part to the underdiagnosis and targeted treatment of underlying secondary forms of hypertension such as PA.…”

“…In this study, we prospectively investigated the prevalence of PA and its main subtypes, APA and BAH, in a large cohort of 1,672 unselected hypertensives consecutively recruited by 19 GPs in Torino, Italy. We observed an overall PA prevalence of 5.9% and an APA was found in 27% of the patients diagnosed with PA (1.6% of the total study population) (Central Illustration).…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…12,13,19 Cholesterol lowering using statins 15,16 and improvement in BP control are cost effective if targeted at persons with high CV risk. 22 Importantly, a sizable portion of patients on lipid-lowering or BP-lowering drug treatment fails to take their treatment adequately or to reach therapeutic goals, 23,24 with clinical and economic consequences.…”

Management of Cardiovascular Risk Factors in High Risk Patients: Correlates of Quality of Care

“…krvnega tlaka, lipidov itn. (6), in raziskav, kako na izvedbo svetovanja družinskega zdravnika vplivajo značilnosti…”

“…Višja vsota predstavlja bolj redno jemanje zdravil. 6 Vsota DA odgovorov: ali zdravstvena kartoteka vsebuje podatke o problemski listi, stalni terapiji, neprenašanju zdravil, označene dejavnike tveganja, sistem za klasifikacijo bolezni 7 Vsota DA odgovorov: dostopnost do interneta, dostopnost do elektronske pošte, protivirusna oprema in zaščita, uporaba računalniškega sistema za vodenje kartotek, uporaba računalnika za izdajanje receptov, izdelani protokoli rezultatov pregleda in preiskav, dostop do kliničnih smernic, strokovne literature, bibliografskih baz podatkov keeping medical records, use of computer system for prescription of medication, existing protocols for results of consultation and examinations, availability of clinical guidelines, professional literature and database. 8 Sum YES answers: does health organisation uses screening methods for patients at high risk, does health organisation uses active approach (inviting patients) 9 Sum YES answers: is information material for patients available in the practice, existence of the list for local activities/organisations for prevention of CVD.…”