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Inadequate management of cardiovascular risk factors prior to admission for an acute coronary event
Christos Siafarikas1, Stavros Liatis1, Christos Kapelios2
1First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527, Athens, Greece.
Insights
Cardiovascular disease prevention, both primary and secondary, often falls short of recommended standards for patients admitted with acute coronary syndrome. This study highlights gaps in risk factor management, including statin use and glycemic control.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Optimal management of modifiable risk factors is crucial for cardiovascular disease (CVD) prevention.
- Current guidelines emphasize risk factor control for both primary and secondary CVD prevention.
- Assessing adherence to preventive strategies before acute coronary events is essential.
Purpose of the Study:
- To evaluate the effectiveness of primary and secondary cardiovascular risk management in patients prior to acute coronary syndrome (ACS) admission.
- To identify gaps in the application of evidence-based preventive strategies.
- To inform future interventions aimed at improving cardiovascular risk factor control.
Main Methods:
- Retrospective analysis of 185 hospitalized ACS patients (July 2019-June 2020).
- Patients categorized into primary and secondary prevention subgroups based on prior CVD history.
- Data collected on demographics, comorbidities (diabetes, dyslipidemia, hypertension), medication use, and risk factor control (LDL-C, HbA1c).
Main Results:
- In secondary prevention, only 33.3% achieved LDL-C targets, and 20% were not on statins; 47.8% of diabetic patients had controlled HbA1c.
- In primary prevention, statin use was low (25.8%), LDL-C targets were unmet in <23.1%, and antiplatelet/anticoagulant use was low (20.1%).
- High rates of active smoking (25% secondary, 46.3% primary) and suboptimal diabetes management were observed.
Conclusions:
- Existing primary and secondary cardiovascular disease prevention strategies are not adequately implemented in a significant proportion of patients presenting with ACS.
- There are critical deficiencies in medication adherence, risk factor control (LDL-C, HbA1c), and lifestyle modifications (smoking).
- Findings underscore the need for improved adherence to clinical guidelines to reduce cardiovascular event recurrence and incidence.
Objectives:
Optimal regulation of modifiable risk factors has been proposed as the standard of care both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to assess primary and secondary cardiovascular risk management received before admission for an acute coronary event.
Methods:
Data were analyzed for 185 consecutive hospitalized patients with a diagnosis of acute coronary syndrome (ACS) in the Cardiology department of a University hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided into two groups, the primary and secondary prevention subgroups, according to previous medical history of cardiovascular disease (CVD).
Results:
The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Previous CVD was present in 51 patients (27.9%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia. Hypertension was present in 101 (54.6%) patients. In the secondary prevention group, the LDL-C was on target in only 33.3% of the patients, while 20% patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only 20% had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in 47.8%. Twenty-five percent of the patients were active smokers. In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk for CVD (47.1% and 32.1% respectively). The LDL-C was on target in less than 23.1% of the patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target in 61.8%. Active smoking was practiced by 46.3% of the patients.
Conclusions:
Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies.
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