Score of adherence to 2016 European cardiovascular prevention guidelines is an independent determinant of cardiovascular and all-cause mortality in a French general population

Abstract

European guidelines on cardiovascular (CV) disease prevention promote healthy lifestyle behaviors and CV risk factor control in order to reduce CV risk. The impact of adherence to these guidelines on CV and all-cause mortality is unknown. We assessed the impact of baseline adherence to “2016 European guidelines on cardiovascular disease prevention in clinical practice” on long-term CV and all-cause mortality in a sample recruited from the French general population. Analysis was based on the Third French MONICA population-based survey (1994–1997). Participants were randomly recruited from the general population of three French areas (North-Eastern, South-Western and Northern France). Participants with a previous medical history of chronic disease or missing data were excluded. We built an adherence score to 2016 European Guidelines, including smoking, drinking, physical activity, body mass index, blood pressure, LDL- and HDL-cholesterol, fasting blood glucose and diet at baseline. Vital status was obtained 18 years after inclusion. Statistical analysis was based on multivariate Cox modelling. Adherence score was assessed in 1311 apparently healthy participants aged 35–64 (73% were men). During the follow-up, 186 deaths occurred (41 were due to a CV cause). Considering CV mortality, the adjusted hazard ratio (HR) for subjects in the fourth quartile of the adherence score (worse adherence) was 3.12 [1.62–6.01] ( P = 0.001), as compared to subjects in the first, second or third quartile (best adherence). Considering all-cause mortality, the adjusted HR for subjects in the fourth quartile of the adherence score was 2.27 [1.68–3.06] ( P < 0.001). Better baseline adherence to 2016 European guidelines on cardiovascular disease prevention significantly reduces long-term CV and all-cause mortality in a sample from the French general population.