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Related Experiment Videos

Changes in Cardiovascular Risk Factors After Protocolized Adherence Reinforcement and Treatment Optimization: Results

José Abellán Alemán1, Javier Nieto Iglesias2, Luis Castilla Guerra3

  • 1Cátedra de Riesgo Cardiovascular, Universidad Católica de Murcia, 30107 Murcia, Spain.

Journal of Clinical Medicine
|July 15, 2026
PubMed
Summary

Protocolized adherence reinforcement and physician-driven treatment optimization improved cardiovascular risk factors in high-risk patients. This combined approach showed significant reductions in blood pressure, LDL cholesterol, and BMI, highlighting the need for both adherence and intensified treatment.

Keywords:
Spaincardiovascular risk factorshealth services researchimplementation sciencemedication adherenceprimary careprimary preventiontherapeutic inertiatreatment intensification

Related Experiment Videos

Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Public Health

Background:

  • Evidence-based guidelines for cardiovascular risk management are often not met by patients.
  • The interplay between medication non-adherence and suboptimal treatment intensification in primary care is not well understood.
  • High-risk patients frequently fail to achieve therapeutic targets, necessitating novel intervention strategies.

Purpose of the Study:

  • To evaluate the impact of a protocolized intervention combining adherence reinforcement and physician-driven treatment optimization on cardiovascular risk factors.
  • To describe changes in blood pressure, lipid profiles, glucose control, and body mass index in high-risk patients.
  • To assess the effectiveness of a dual approach addressing both medication adherence and treatment intensification.

Main Methods:

  • A multicenter, real-world, longitudinal, single-arm, pre-post study involving 789 high or very high cardiovascular risk participants from Spanish primary care settings.
  • Intervention involved protocolized adherence reinforcement and physician-driven treatment optimization over a 90-day follow-up period.
  • Outcomes included changes in systolic and diastolic blood pressure, total cholesterol, LDL-c, HDL-c, triglycerides, glucose, HbA1c, and BMI, analyzed using linear mixed models.

Main Results:

  • Significant improvements were observed in systolic blood pressure (-9.24 mmHg), diastolic blood pressure (-4.75 mmHg), LDL-c (-22.29 mg/dL), total cholesterol (-23.24 mg/dL), triglycerides (-16.75 mg/dL), fasting plasma glucose (-10.03 mg/dL), and BMI (-0.46 kg/m²).
  • HDL-c and HbA1c did not show significant changes.
  • Treatment was modified in 82.0% of participants, indicating substantial physician-driven treatment intensification alongside adherence reinforcement.

Conclusions:

  • Protocolized adherence reinforcement coupled with physician-driven treatment optimization led to clinically meaningful improvements in multiple cardiovascular risk factors in high-risk primary care patients.
  • The study design limits causal attribution, but findings suggest that addressing both medication adherence and treatment intensification is crucial for optimal cardiovascular risk factor control.
  • Residual uncontrolled risk, particularly for lipids and in older adults, indicates a need for continued efforts in treatment intensification, even after adherence has been addressed.