A comprehensive guidelines-based approach reduces cardiovascular risk in everyday practice: the VARO study

Abstract

IntroductionThe aim of study was to investigate the possibility of cardiovascular risk improvement through systematic identification of high-risk individuals and treatment in accordance with current guidelines using modern therapy in daily clinical practice.Material and methodsTwo hundred and sixty-three physicians participated in the study. The physicians were asked to screen for cardiovascular risk factors in patients presenting with unrelated problems and to re-evaluate the attainment of treatment goals in those with already known risk factors. Each physician enrolled up to 20 consecutive patients with hypertension and/or hyperlipidemia. A total of 3015 patients were included. Cardiovascular risk was assessed using the SCORE system. Risk factors were treated in accordance with current national guidelines. The therapy of hyperlipidemia and hypertension was preferentially based on rosuvastatin, amlodipine and valsartan. Further medication was at the discretion of the attending physician. Patients were examined at baseline and after 3 and 6 months.ResultsThe principal result is that global cardiovascular risk decreased by 35% (from 8.9 ±6.4 to 5.9 ±4.4, p < 0.001). Systolic and diastolic blood pressure decreased by 12.5% (from 152 ±18 to 133 ±11, p < 0.001) and 11.4% (from 88 ±11 to 78 ±7, p < 0.001). The level of total cholesterol decreased 21% (from 6.3 ±1.2 to 5.0 ±0.9, p < 0.001) and the concentration of LDL-C decreased 28% (from 3.9 ±1.1 to 2.8 ±0.8, p < 0.001). HDL-C increased by 7% (from 1.43 ±0.58 to 1.53 ±0.56, p < 0.001) and triglycerides decreased by 25% (from 2.4 ±1.3 to 1.8 ±0.9, p < 0.001). Blood pressure and LDL-C target values were reached in 68% and 34%of patients, respectively.ConclusionsThe VARO study demonstrates that in daily practice settings, both individual risk factors and global cardiovascular risk are significantly improved through the systematic identification of high-risk individuals and their treatment in accordance with current guidelines using modern pharmacotherapy.

Associations of dipping and non-dipping hypertension with cardiovascular diseases in patients with dyslipidemia

“…The following possibilities might be ascribed to these findings. First, blunted BP reduction during nighttime is commonly associated with enhanced sympathetic activity, which in turn increases heart rate and cardiac output [ 19 – 21 ]. Of note, these hemodynamic alterations are detrimental to cardiovascular systems, thereby increasing CVD risk.…”

Increased platelet reactivity in dyslipidemic patients with coronary artery disease on dual anti-platelet therapy

“…Recently, Mendelian randomization studies have doubted a causal relationship between genetically low levels of HDL and cardiovascular outcome [22]. Nevertheless, HDL remains a well-accepted marker of metabolic control, insulin sensitivity and modifiable cardiovascular risk [13, 17, 23, 24]. Notably, in our study, HDL-C was a more accurate predictor of on-treatment platelet function than HbA 1c levels, history of diabetes, TG levels or known hyperlipidemia (Tables II, III).…”

Ankyrins in human health and disease – an update of recent experimental findings

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