Abstract
Background: The extent of cardiovascular risk reduction by implementing coronary prevention guidelines needs to be documented in various population samples.
Hypothesis: This is a multicenter study to assess the impact of risk reduction in cardiovascular events upon implementation of coronary prevention guidelines in patients with or at high risk for coronary heart disease (CHD) in the setting of clinical practice.
Methods: Enrolled volunteers numbered 2,021. Inclusion criteria postulated a minimum of 20–40% cardiovascular event risk in the subsequent 10 years as estimated from the risk table of the European Society of Cardiology (ESC) Guidelines. The estimated CHD risk reduction was assessed in terms of the Framingham risk scores at baseline and at 12 months, computed from the data of each individual. Data of the compliant group (making up half of the initial participants) at the end of the study, along with absolute and relative risk reductions in the compliant group, were analyzed.
Results: Mean global risk burden was 25.9% at baseline, reduced through multilateral preventive measures in absolute terms by 9.4% at 6 months and by 11.7% at 12 months; the latter represents a relative risk reduction of 44%. Independent variables determining the (enhanced) reduction in risk level at the end of 12 months included (high) level of baseline risk, (high) degree of compliance with treatment, younger age, female gender, smoking, and (high) baseline triglyceride/high‐density lipoprotein cholesterol (TC/HDL‐C) ratio.
While the relative reduction in patients with CHD amounted to 43%, a reduction of 46% (p < 0.001) was obtained in the setting of primary prevention. Diabetes emerged as a factor modestly limiting the extent of risk reduction. While subjects without hypertension revealed a decline of coronary risk by merely 8.7%, those with hypertension showed a decline by 12.7% (p < 0.001). Risk reductions were accompanied by a decrease of mean low‐density lipoprotein cholesterol (LDL‐C) level of 25.4%, a rise in mean HDL‐C level of 5 mg/dl, a decrease in mean systolic blood pressure of 26 mmHg. Forty‐five percent of smokers succeeded in discontinuing the habit.
Conclusion: By implementing standard prevention guidelines in the Turkish population among 1,000 compliant high‐risk men and women and among 1,000 patients with CHD, prevention of cardiovascular events could be expected in 117 persons in the subsequent 10 years.
Keywords: coronary risk reduction, guideline implementation, preventive cardiology
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References
- 1. Pyörala K, De Backer G, Graham I, Poole‐Wilson P, Wood D: Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclorosis Society, and European Society of Hypertension. Eur Heart J 1994; 15: 1300–1331 [DOI] [PubMed] [Google Scholar]
- 2. Türk Kardiyoloji Derneǧi: Koroner Kalp Hastaliǧindan Korunma ve Tedaviye Ilişkin Ulusal Kilavuz. Istanbul: Türk Kardiyol Dern, 1995. [Google Scholar]
- 3. Murray CJL, Lopez AD: Alternative projections of mortality and disability by cause 1990–2020: Global burden of disease study. Lancet 1997; 349: 1498–1504 [DOI] [PubMed] [Google Scholar]
- 4. Pearson TA, Smith SC Jr, Poole‐Wilson P: Cardiovascular Specialty Societies and the emerging global burden of cardiovascular disease: A call to action. Circulation 1998; 97: 602–604 [DOI] [PubMed] [Google Scholar]
- 5. European Forum on the Prevention of Coronary Heart Disease in Clinical Practice (19‐21 February 1999). Newsletter by European Society of Cardiology, 1999. (May); vol. 8 (no. 2) [Google Scholar]
- 6. Capewell S, Pell JP, Morrison C, McMurray J: Increasing the impact of car‐diological treatments: How best to reduce deaths. Eur Heart J 1999; 20: 1386–1392 [DOI] [PubMed] [Google Scholar]
- 7. Onat A, Sansoy V, Ince E, Dönmez K, Keleş I, Ökçün B, Kahraman G, Dursunoǧlu D: Türk erişkinlerinde kanda kolesterolde istikrar, trigliseridde yükselme. Türk Kardiyol Dern Arş 1996; 24: 392–398 [Google Scholar]
- 8. Onat A: Risk factors and cardiovascular disease in Turkey. Atherosclerosis 2001; 156: 1–10 [DOI] [PubMed] [Google Scholar]
- 9. Mahley RW, Palaoǧlu KE, Atak Z, Dawson‐Pepin J, Langlois A‐M, Cheung V, Onat H, Fulks P, Mahley LL, Vakar F, Özbayrakçi S, Gökdemir O, Winkler W: Turkish Heart Study: Lipids, lipoproteins and apolipopro‐teins. J Lipid Res 1995; 36: 839–859 [PubMed] [Google Scholar]
- 10. Onat A, Dursunoǧlu D, Sansoy V: Relatively high coronary death and event rates in Turkish women: Relation to three major risk factors in five‐year follow‐up of cohort. Int J Cardiol 1997; 61: 69–77 [DOI] [PubMed] [Google Scholar]
- 11. Anderson KM, Wilson PWF, Odell PM, Kannel WB: An updated coronary risk profile: A statement for health professionals. Circulation 1991; 83: 356–362 [DOI] [PubMed] [Google Scholar]
- 12. Dawson‐Saunders B, Trapp RG: Basic and Clinical Biostatistics. Engle‐wood Cliffs, N. J.: Prentice‐Hall International Inc., Appleton & Lange; [Google Scholar]
- 13. Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörala K: Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of the European and other societies on coronary prevention. Eur Heart J 1998; 19: 1434–1503 [DOI] [PubMed] [Google Scholar]
- 14. Menotti A, Puddu PE, Lanti M: Comparison of the Framingham risk function‐based coronary chart with risk function from an Italian population study. Eur Heart J 2000; 21: 365–370 [DOI] [PubMed] [Google Scholar]
- 15. Sacks FM, Pfeffer MA, Moyé LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnicka JW, Arnold JMO, Wun C‐C, Davis BR, Braunwald E: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–1009 [DOI] [PubMed] [Google Scholar]
- 16. EUROASPIRE Study Group : EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease: Principal results. Eur Heart J 1997; 18: 1569–1582 [DOI] [PubMed] [Google Scholar]
- 17. van Berkel TFM, Boersma H, De Baquer D, Deckers JW, Wood D, on behalf of the EUROASPIRE Study Group : Registration and management of smoking behaviour in patients with coronary heart disease. The EURO‐ASPIRE Survey. Eur Heart J 1999; 20: 1630–1637 [DOI] [PubMed] [Google Scholar]
- 18. Shepherd J: A call to action. Eur Heart J 1998; 19 (suppl M): M2–M7 [PubMed] [Google Scholar]
- 19. Assmann G, Cullen P, Schulte H: Simple scoring scheme for calculating the risk of acute coronary events based on the 10‐year follow‐up of the Prospective Cardiovascular Münster (PROCAM) study. Circulation 2002; 105: 310–315 [DOI] [PubMed] [Google Scholar]