Abstract
BackgroundIt is unknown whether population based single assessment of cardiovascular disease (CVD) risk and feedback to individuals and general practitioners results in initiation of preventive cardiovascular pharmacotherapy in those at risk. MethodsThe population based cohort study Lifelines was linked to the IADB.nl pharmacy database to assess information on the initiation of preventive medication (N = 48,770). At the baseline visit, information on cardiovascular risk factors was collected and reported to the participants and their general practitioners. An interrupted-time-series-analysis was plotted, in which the start year of blood pressure and lipid lowering medication was displayed in years before or after the baseline visit. Subsequently, predictors of the initiation of pharmacotherapy were determined and possible reduction in cardiovascular events that could be achieved by optimal treatment of individuals at risk. ResultsBefore the Lifelines baseline visit, 34% (out of 1,527, 95% Confidence interval (CI) 32%–36%) and 30% (out of 1,991, 95%CI 28%–32%) of the individuals at risk had a blood pressure or lipid lowering drug prescription, respectively. In those at risk, the use of blood pressure lowering medication, increased substantially during the year of the baseline visit. Treating individuals at increased risk (≥5% 10-year risk) with lipid or blood pressure lowering medication (N = 8515 and N = 6899) would have prevented 162 and 183 CVD events, respectively, in the upcoming five years. ConclusionPrimary prevention of CVD in the general population appears suboptimal. Feedback of cardiovascular risk factors resulted in a substantial increase of blood pressure lowering medication and extrapolated health benefits.
Highlights
In the European Union, cardiovascular death accounts for approximately 37% of total mortality rates [1]
Results according to the Dutch Nederlands Huisartsen Genootschap (NHG) guidelines are reported in Supplementary Tables 2–4, and show similar findings for the initiation of preventive medication after the Lifelines baseline visit
In univariate logistic regression analyses, female sex, age, socioeconomic status and total cholesterol-high density lipoprotein (HDL) ratio were associated with the use of preventive pharmacotherapy in individuals at increased risk according to the European Society of Cardiology (ESC) guideline
Summary
In the European Union, cardiovascular death accounts for approximately 37% of total mortality rates [1]. The GP decides whether or not to further investigate the presence of cardiovascular risk factors by making inquiries about lifestyle habits and by measuring blood pressure and serum lipid levels. This results in a cardiovascular risk profile, based on the Systematic Coronary Risk. Results: Before the Lifelines baseline visit, 34% (out of 1,527, 95% Confidence interval (CI) 32%–36%) and 30% (out of 1,991, 95%CI 28%–32%) of the individuals at risk had a blood pressure or lipid lowering drug prescription, respectively. Feedback of cardiovascular risk factors resulted in a substantial increase of blood pressure lowering medication and extrapolated health benefits
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