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Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary
Ola Vedin1, Emil Hagström, Ralph Stewart
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden. ola.vedin@akademiska.se
Insights
Many patients with cardiovascular disease do not meet treatment goals despite receiving preventive therapies. This global study highlights high cardiovascular risk factors and suboptimal control in secondary prevention populations worldwide.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Limited contemporary data exists on cardiovascular disease risk factor control in secondary prevention globally.
- The STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial provides a unique dataset on this topic.
Purpose of the Study:
- To describe the global and regional prevalence of cardiovascular risk factors.
- To assess the achievement of risk factor goals for secondary prevention of cardiovascular disease.
- To report the use of preventive medications at baseline in the STABILITY trial.
Main Methods:
- Analysis of baseline data from 15,828 patients with chronic coronary heart disease across 39 countries.
- Inclusion criteria: history of myocardial infarction, prior coronary revascularization, or multi-vessel coronary heart disease without revascularization, plus at least one additional cardiovascular risk factor.
- Data collected on cardiovascular risk factors, medication use, and achievement of guideline-recommended targets.
Main Results:
- High prevalence of cardiovascular risk factors observed globally.
- Majority of patients received statins (97%), antiplatelet therapy (96%), beta-blockers (79%), and ACEI/ARB (77%).
- Suboptimal control: LDL cholesterol >2.5 mmol/l (29%), blood pressure ≥140/90 mmHg or ≥130/80 mmHg (46%), obesity (36% BMI >30 kg/m², 54% high waist circumference), and smoking (18%). Regional variations noted, particularly for LDL cholesterol and obesity.
Conclusions:
- Modifiable cardiovascular risk factors are highly prevalent in the STABILITY trial population.
- Despite widespread use of evidence-based secondary preventive therapies, many patients did not achieve recommended secondary prevention goals.
- Significant regional differences in risk factor prevalence and target achievement exist.
Aim:
There is limited contemporary data on achievement of risk factor goals for secondary prevention of cardiovascular (CV) disease from countries in many regions of the world. This report describes the global and regional prevalence of CV risk factors and use of preventive medications at baseline in participants in the ongoing STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial.
Methods And Results:
Detailed individual data on CV risk factors were obtained before randomization in 15,828 patients with chronic coronary heart disease (CHD) from 39 countries on five continents. Subjects had a history of myocardial infarction, prior coronary revascularization, or multi-vessel CHD without revascularization and at least one additional CV risk factor. The majority were taking a statin (97%), antiplatelet therapy (96%), beta-blocker (79%), or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (77%). However, a large proportion of patients did not achieve guideline-recommended targets. For instance, in 29% low-density lipoprotein (LDL) cholesterol was >2.5 mmol/l and in 46% blood pressure was ≥140/90 mmHg or ≥130/80 mmHg in those with diabetes or renal impairment. The body mass index was >30 kg/m(2) in 36%, waist circumference ≥102 cm for men or ≥88 cm for women in 54%, and 18% were smoking. Regional differences in risk factor prevalence and target achievement were observed and were more marked for LDL cholesterol and obesity.
Conclusion:
The prevalence of modifiable CV risk factors was generally high in the STABILITY population. Although, most patients were receiving evidence-based secondary preventive therapy many subjects from all regions did not reach recommended secondary prevention goals.
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