254: Evaluation of cardiovascular risk and excess of risk according to age in high risk primary care patients not treated with lipid-lowering treatment in France

Abstract

Few data exist on high cardiovascular risk (HCVR) prevalence within a primary prevention population. The goals of the present study were: 1) to assess HCVR distribution according to SCORE, in France, for high-risk primary care patients not treated for dyslipidemia; 2) to compare risk assessment by physician and risk SCORE estimate; 3) to define the excess of risk (ER) due to other risk factor than age. This observational study was conducted over a week within a representative sample of French general practitioners (GP). All consulting primary care men/women aged ≥50/60 y, with at least one other risk factor (RF) (smoking, high blood pressure (HBP), type 2 diabetes, HDL-c<0.40 g/L), not treated for dyslipidemia were included in the study. GP filled-in an on line questionnaire that enabled SCORE risk calculation in real time. ER was calculated from a “theoretical” SCORE, namely patient with no RF: total cholesterol=6 mmol/L, Systolic BP=120 mmHg, no smoking. GPs (n=1147) included 9049 patients with the following characteristics: mean age: 68y; male: 57%; LDLc>1.3 g/L: 57%; smoking: 21%; HBP: 44%; type 2 diabetes: 21% HDL-c<0.4 g/L: 16%. According to SCORE, 50% of the patients were at HCVR. CVR was correctly assessed for 45.9% of the patients and under estimated for 62.8% HCVR patients. There was little correlation between GPs risk assessment and SCORE results: Kappa=0.078 [IC95%=0.062-0.094]; weighted Kappa=0.097 [0.082-0.112]. Mean ER increased with age, from 1.1/0.9% to 4.5/3.6% for male (50y to >75y))/female (60y to >75y). At the end of the study, 85% of the GP declared that SCORE was useful in HCVR identification and 87% declared that they will use it in the future. In France, 50% of the patients consulting in primary care with at least 1 RF on top of age and no lipid-lowering treatment have a high SCORE. GPs tend to underestimate their patient's risk as compared to objective SCORE risk assessment. Excess risk increases with age.