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Adherence to guidelines to prevent cardiovascular diseases: The LifeLines cohort study
J W Balder1, S Scholtens, J K de Vries
1Department of Pediatrics, Section Molecular Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
Insights
Undertreatment of lipid-lowering drugs (LLD) for cardiovascular disease (CVD) prevention is high in the Netherlands. Many eligible patients, especially for primary prevention and stroke, do not use LLDs, indicating a gap in CVD risk management.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a leading global cause of mortality.
- Statin therapy is proven to reduce CVD burden, yet undertreatment persists.
- National guidelines exist for CVD prevention and treatment.
Purpose of the Study:
- To assess lipid-lowering drug (LLD) use in the Netherlands.
- To evaluate adherence to national CVD prevention guidelines.
- To identify gaps in primary and secondary CVD prevention.
Main Methods:
- Analysis of 70,292 participants from the population-based LifeLines cohort study.
- Assessment of eligibility for LLD prescription based on national guidelines.
- Comparison of eligible individuals with reported LLD use.
Main Results:
- 77% of individuals eligible for primary CVD prevention and 31% for secondary prevention were not using LLDs.
- Patients with diabetes mellitus showed higher LLD use (67%) for primary prevention.
- Only 47% of stroke patients reported LLD treatment for secondary prevention.
Conclusions:
- Adherence to CVD treatment guidelines in the Netherlands is a significant challenge.
- Improved public awareness and enhanced primary/secondary prevention strategies are crucial.
- Addressing undertreatment of LLDs can reduce CVD-related morbidity and mortality.
Background:
Cardiovascular disease (CVD) is the leading cause of death worldwide. While there is indisputable evidence that statin treatment reduces the burden of CVD, undertreatment remains a concern for primary and secondary prevention. The aim of this study was to assess the use of lipid-lowering drugs (LLD) among 70,292 individuals in the Netherlands as a proxy of adherence to the national guideline for prevention and treatment of CVD.
Methods:
LifeLines is a population-based prospective cohort study in the three Northern provinces of the Netherlands. At baseline, all participants completed questionnaires, and underwent a physical examination and lab testing. The national guidelines were used to assess how many participants were eligible for LLD prescription and we analysed how many indeed reported LLD use.
Results:
For primary prevention, 77% (2515 of 3268) of those eligible for LLD treatment did not report using these drugs, while for secondary prevention this was 31% (403 of 1302). Patients with diabetes mellitus were treated best (67%) for primary prevention. Notably, of the patients with stroke, only 47% (182 of 386) reported LLD treatment.
Conclusion:
Despite clear guidelines and multiple national initiatives to improve CVD risk management, adherence to guidelines for the treatment of CVD in the Netherlands remains a major challenge. This study calls out for improving public awareness of CVD and to improve primary and secondary prevention to prevent unnecessary CVD-related morbidity and mortality.
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