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The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International
Dirk J Blom1, Raul D Santos2, Veronique Daclin3
1University of Cape Town, Cape Town, South Africa.
Insights
Achieving control of multiple cardiovascular risk factors like LDL-C, diabetes, and blood pressure is challenging for high-risk patients globally. Poor control of one factor often correlates with inadequate management of others, highlighting a significant public health concern.
Area of Science:
- Cardiology
- Public Health
- Endocrinology
Background:
- Comprehensive control of cardiovascular risk factors is crucial for reducing cardiovascular events.
- Simultaneous management of multiple risk factors remains a significant clinical challenge worldwide.
- Current guidelines emphasize aggressive risk factor modification for high-risk individuals.
Purpose of the Study:
- To investigate the achievement of guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets in patients on lipid-modifying therapy.
- To examine the rate of, and associations between, simultaneous control of multiple cardiovascular risk factors (LDL-C, diabetes, hypertension) in high-risk patients.
- To assess risk factor control across different countries outside Western Europe.
Main Methods:
- A multinational, cross-sectional, observational study involving 2377 patients with dyslipidaemia, diabetes, and hypertension.
- Data collection on patient demographics, comorbidities (metabolic syndrome, obesity, atherosclerotic disease), cardiovascular risk stratification, and lifestyle factors (smoking, BMI).
- Analysis of the achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline targets for LDL-C, blood pressure, and diabetes control.
Main Results:
- Only 12.2% of high-risk patients achieved simultaneous control of LDL-C, diabetes, and blood pressure.
- Individual target achievement rates were 43.9% for LDL-C, 55.5% for blood pressure, and 39.3% for diabetes.
- Multiple correspondence analysis revealed associations between the control of LDL-C, blood pressure, diabetes, BMI, and smoking status.
Conclusions:
- Comprehensive control of multiple cardiovascular risk factors in high-risk patients is suboptimal globally.
- Failure to control one modifiable risk factor is significantly associated with poor control of other risk factors.
- Interventions targeting simultaneous risk factor management are essential to improve cardiovascular outcomes in high-risk populations.
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.
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