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Does present use of cardiovascular medication reflect elevated cardiovascular risk scores estimated ten years ago? A
1Department of General Practice/FamilyMedicine, Institute of Health and Society, University of Oslo, Norway. mette.brekke@medisin.uio.no
Insights
Cardiovascular medication use in middle-aged adults appears unrelated to estimated cardiovascular risk, particularly for women. This suggests preventive measures may not prioritize high-risk individuals effectively.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Cardiovascular disease (CVD) prevention strategies aim to prioritize high-risk individuals.
- Assessing the correlation between current cardiovascular medication use (CVM) and estimated CVD risk from a decade prior is crucial for evaluating preventive measure effectiveness.
Purpose of the Study:
- To investigate the extent to which current CVM use aligns with cardiovascular risk scores (Framingham, SCORE, NORRISK) calculated ten years earlier.
- To identify factors associated with CVM prescription in a middle-aged cohort.
Main Methods:
- Prospective longitudinal observational study of 20,252 participants (born 1950-57) from The Hordaland Health Study, initially not using CVM (1997-99).
- Prescription data was obtained from The Norwegian Prescription Database in 2008.
- Cardiovascular risk was estimated using Framingham, SCORE, and NORRISK algorithms.
Main Results:
- 26% of men and 22% of women aged 51-58 initiated CVM in the preceding decade.
- Individuals using CVM generally had higher risk scores than non-users.
- A significant proportion of individuals with high-risk scores did not receive CVM (60-65% of men, 25-45% of women).
- Factors like low education, poor self-reported health, pain, mental distress (women), and family history correlated with CVM use; elevated blood pressure was the strongest predictor.
Conclusions:
- CVM prescription in middle-aged individuals appears largely independent of estimated total cardiovascular risk.
- This disconnect is particularly pronounced in women, indicating potential gaps in risk-stratified preventive care.
Background:
It is desirable that those at highest risk of cardiovascular disease should have priority for preventive measures, eg. treatment with prescription drugs to modify their risk. We wanted to investigate to what extent present use of cardiovascular medication (CVM) correlates with cardiovascular risk estimated by three different risk scores (Framingham, SCORE and NORRISK) ten years ago.
Methods:
Prospective logitudinal observational study of 20,252 participants in The Hordaland Health Study born 1950-57, not using CVM in 1997-99. Prescription data obtained from The Norwegian Prescription Database in 2008.
Results:
26% of men and 22% of women aged 51-58 years had started to use some CVM during the previous decade. As a group, persons using CVM scored significantly higher on the risk algorithms Framingham, SCORE and NORRISK compared to those not treated. 16-20% of men and 20-22% of women with risk scores below the high-risk thresholds for the three risk scores were treated with CVM, while 60-65% of men and 25-45% of women with scores above the high-risk thresholds received no treatment. Among women using CVM, only 2.2% (NORRISK), 4.4% (SCORE) and 14.5% (Framingham) had risk scores above the high-risk values. Low education, poor self-reported general health, muscular pains, mental distress (in females only) and a family history of premature cardiovascular disease correlated with use of CVM. Elevated blood pressure was the single factor most strongly predictive of CVM treatment.
Conclusion:
Prescription of CVM to middle-aged individuals by large seems to occur independently of estimated total cardiovascular risk, and this applies especially to females.
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