Control of cardiovascular risk factors and its determinants in the general population– findings from the STAAB cohort study

Abstract

BackgroundWhile data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD).MethodsData from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed.ResultsBetween December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11).ConclusionsIn the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0708-x) contains supplementary material, which is available to authorized users.

2018 ESC/ESH Guidelines for the management of arterial hypertension

“…This is supported by studies in the general population in which adherence to treatment, based on prescription refilling, was <50% of the treatment in half of the patients [312]. Poor adherence has also been shown to be associated with increased cardiovascular risk in various studies [313] (see Section 10 There is also evidence that adherence to treatment is adversely affected by the complexity of the prescribed treatment regimen. In a recent study, adherence to treatment was strongly influenced by the number of pills that a patient was prescribed for the treatment of hypertension [315].…”

High prevalence of cardiovascular risk factors in adults living in Greece: The EMENO National Health Examination Survey

“…Liatis et al [30], using the electronic prescription database of the National Organization for Health Care Services Provision estimated a prevalence of medication-prescribed diabetes of 8.2% in adults, an estimate compatible with ours given that in our study both diagnosed and undiagnosed adults irrespectively of their treatment were included. Diabetes prevalence in Greece is similar to that in Spain (10.6%) [21], lower than that in China (16.8%) and the US (19.3%) [31], but substantially higher compared to that in other European countries like Germany, where diabetes prevalence was found equal to 3.5% [32]. The increased prevalence of obesity as well as the nancial crisis may have contributed to this increased diabetes prevalence in Greece.…”

Latin American recommendations for the management of hypertension in adults (RELAHTA 2)

“…La falta de adherencia terapéutica es una de las principales causas del bajo porcentaje de control (80,81) de la PA y se relaciona con un incremento de eventos cardiovasculares . La adherencia terapéutica en HTA es baja, y un estudio sobre adherencia al tratamiento (ENSAT) a los 6 meses de (82) iniciado el fármaco mostró que el 52 % de los pacientes fueron considerados como no adherentes .…”