The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International ChoLesterol management Practice Study

Abstract

Background Comprehensive control of multiple cardiovascular risk factors reduces cardiovascular risk but is difficult to achieve. Design A multinational, cross-sectional, observational study. Methods The International ChoLesterol management Practice Study (ICLPS) investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in patients receiving lipid-modifying therapy in countries outside Western Europe. We examined the rate of, and association between, control of multiple risk factors in ICLPS participants with dyslipidaemia, diabetes and hypertension (N = 2377). Results Mean (standard deviation) age of patients was 61.4 (10.4) years; 51.3% were male. Type 2 diabetes was the most common form of diabetes (prevalence, 96.9%). The prevalence of metabolic syndrome was 67.8%, obesity 40.4%, atherosclerotic disease 39.6% and coronary artery disease 33.5%. All patients were at high (38.2%) or very high (61.8%) cardiovascular risk according to ESC/EAS guidelines. Body mass index (BMI) was <25 kg/m2 in 20.3% of patients, 62.8% had never smoked and 25.2% were former smokers. Overall, 12.2% achieved simultaneous control of LDL-C, diabetes and blood pressure. Risk factor control was similar across all participating countries. The proportion of patients achieving individual guideline-specified treatment targets was 43.9% for LDL-C, 55.5% for blood pressure and 39.3% for diabetes. Multiple correspondence analysis indicated that control of LDL-C, control of blood pressure, control of diabetes, BMI and smoking were associated. Conclusion Comprehensive control of multiple cardiovascular risk factors in high-risk patients is suboptimal worldwide. Failure to control one risk factor is associated with poor control of other risk factors.

Metabolic control achievement in a population with premature coronary artery disease: results of the genetics of atherosclerotic disease study

“… 4 – 8 In this context, several studies have reported that simultaneous achievement of cardiovascular risk prevention goals is poor. 9 , 10 , 17 , 18 To the best of our knowledge, the present study is the first to analyze the composite cardiovascular risk factors control in premature CAD patients, using former and recent stringent criteria. Our results highlight that less than 20% and 10% of premature CAD patients achieved non-strict or strict metabolic control, respectively.…”

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

“…In a large outpatient cohort in Italy, LDL-C levels were poorly controlled despite lipid-lowering therapy and lifestyle recommendations; none of the primary prevention patients with very high SCORE risks achieved the LDL-C target of <70 mg/dL (<1.8 mmol/L), and only 9% of high SCORE risk patients had an LDL-C of <100 mg/dL (2.6 mmol/L) [27]. In countries outside Western Europe, the proportion of high or very high CVD risk patients achieving treatment targets was 44% for LDL-C, 56% for blood pressure and 39% for diabetes, but only one-tenth of patients achieved simultaneous control of LDL-C, diabetes and blood pressure [25].…”

“…Especially low control rates were found for LDL-C (4.5%) and body weight parameters (15%). Numerous observational studies, including previous EUROASPIRE surveys, concluded that control of multiple cardiovascular risk factors is poor in clinical practice [20,[23][24][25][26][27], and it is even more difficult to achieve the targets in the primary prevention setting than in coronary patients [20]. In the primary care arm of EUROASPIRE IV, less than half (43%) of the treated patients reached the blood pressure target, one-third (33%) of patients achieved the LDL-C target of <2.5 mmol/L and less than two-thirds (59%) achieved the HbA1c target of <7.0%.…”

Multiple cardiovascular risk factor control: still a challenge?

“…The aim of the study discussed in this editorial 9 was to evaluate the level of, and association between, multiple risk factor control in patients with dyslipidemia, diabetes and hypertension, in whom LDL-cholesterol, blood pressure and haemoglobin A1c (HbA1c) could be assessed. Its hypothesis was that patients with low control of one risk factor are less likely to achieve the control of others, in different countries and continents.…”

“…The authors state that the control of risk factors did not differ markedly among countries and was identical to European countries with documented CAD. 9 However, the recently published paper of Euroaspire V latest results 7 referred only to patients with documented CAD and the ICLPS 9 included a heterogeneous population, without CAD and with CAD. Nevertheless, it confirms the need for better risk factor control, which will necessarily include strategies to support adherence to lifestyle modification and medication.…”