Risk Factor Treatment and Control in Relation to Coronary Disease Risk in the Spanish Population of the DARIOS Study

Abstract

Introduction and objectives The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90 mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. Results We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension ( P < .001), 66% and 69% respectively, of patients with diabetes ( P = .03), and 39% and 42% respectively, of those with hypercholesterolemia ( P < .001). Control was good in 34% of men and 42% of women with hypertension ( P < .001); 65% and 63% respectively, of those with diabetes ( P = .626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria ( P = .092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria ( P < .001). The proportion of uncontrolled participants increased with coronary risk ( P < .001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P < .024). Conclusions The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.