Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
BMC Public Health (Impact Factor: 2.26). 09/2011; 11(1):704. DOI: 10.1186/1471-2458-11-704
Source: PubMed


Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe.
Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account.
The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27).
Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

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Available from: Philippe Gabriel Steg, Jan 27, 2014
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    • "Many studies on cardiovascular prevention have focused on the population older than 40 or 50 years [7,8] or on a wide age range population [9] and have dealt with their risk assessment. Only a few studies have addressed cardiovascular prevention for young people [10]. "
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    ABSTRACT: Background One of the main family practice interventions in the younger healthy population is advice on how to keep or develop a healthy lifestyle. In this study we explored the level of counselling regarding healthy lifestyle by family physicians and the factors associated with it. Methods A cross-sectional study with a random sample of 36 family practices, stratified by size and location. Each practice included up to 40 people aged 18–45 with low/medium risk for cardiovascular disease (CVD). Data were obtained by patient and practice questionnaires and semi-structured interviews. Several predictors on the patient and practice level for received advice in seven areas of CVD prevention were applied in corresponding models using a two-level logistic regression analysis. Results Less than half of the eligible people received advice for the presented risk factors and the majority of them found it useful. Practices with medium patient list-sizes showed consistently higher level of advice in all areas of CVD prevention. Independent predictors for receiving advice on cholesterol management were patients’ higher weight (regression coefficient 0.04, p=0.03), urban location of practice (regression coefficient 0.92, p=0.04), organisation of education by the practice (regression coefficient 0.47, p=0.01) and practice list size (regression coefficient 6.04, p=0.04). Patients who self-assessed their health poorly more frequently received advice on smoking (regression coefficient −0.26, p=0.03). Hypertensive patients received written information more often (regression coefficient 0.66, p=0.04). People with increased weight more often received advice for children’s lifestyle (regression coefficient 0.06, p=0.03). We did not find associations with patient or practice characteristics and advice regarding weight and physical activity. We did not find a common pattern of predictors for advice. Conclusions Counselling for risk diseases such as increased cholesterol is more frequently provided than basic lifestyle counselling. We found some doctors and practice factors associated with counselling behaviour, but the majority has to be explained by further studies.
    BMC Family Practice 06/2013; 14(1):82. DOI:10.1186/1471-2296-14-82 · 1.67 Impact Factor
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    • "In the absence of structured interventions against other major cardiovascular risk factors, it must be inferred that this effect was substantially, if not entirely, the result of the reduction in systolic blood pressure. Whether or not the reduction in mean SCORE value represents the maximum such effect that can be expected from the achieved degree of systolic blood pressure control remains to be established (see Guallar et al8 for a recent contribution in this area). It remains also to be established if the observed reduction in mean SCORE value represents a broad-based effect in the generality of the POWER population or if it is the result of an effect concentrated in a subset of patients with distinct demographic characteristics. "
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    ABSTRACT: Estimation of total cardiovascular risk is useful for developing preventive strategies for individual patients. The POWER (Physicians' Observational Work on Patient Education According to their Vascular Risk) survey, a 6-month, open-label, multinational, post-marketing observational evaluation of eprosartan, an angiotensin II receptor blocker, was undertaken to assess the efficacy and safety of eprosartan-based therapy in the treatment of high arterial blood pressure in a large population recruited from 16 countries with varying degrees of baseline cardiovascular risk, and the effect of eprosartan-based therapy on total cardiovascular risk, as represented by the SCORE(®) (Systematic Coronary Risk Assessment) or Framingham risk equations. Participating physicians recruited > 29,000 hypertensive patients whom they considered to be candidates (according to specified criteria) for treatment with eprosartan 600 mg/day, with other drugs added at the discretion of the physician. During treatment, systolic blood pressure decreased by 25.8 ± 14.4 mmHg to 134.6 ± 11.4 mmHg (P < 0.001), mean diastolic blood pressure fell by 12.6 ± 9.5 mmHg to 81.1 ± 7.6 mmHg, and pulse pressure fell by 13.2 ± 13.5 mmHg to 53.6 ± 11.4 mmHg (both P < 0.01). Calculated total cardiovascular risk declined in parallel with the reduction in blood pressure. The POWER study has demonstrated, in a large and nonselected population, the feasibility and practicability of reducing total cardiovascular risk through systematic management of high blood pressure.
    Vascular Health and Risk Management 09/2012; 8(1):563-8. DOI:10.2147/VHRM.S34834
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    • "Results from EURIKA study (Guallar et al, 2011), which involved participants from 12 European countries with at least one cardiovascular risk, but without CVD reported that the average 10-year risk of CVD death in study participants was 8.2%. Hypertension was responsible for 32.7%, hyperlipidemia for 15.1%, smoking for 10.4%, and diabetes for 16.4% of CVD risk. "

    Recent Advances in Cardiovascular Risk Factors, 01/2012; InTech.
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