Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level

Daria Roccatagliata¹, Fausto Avanzini¹, Lara Monesi¹, Vittorio Caimi², Davide Lauri¹, Paolo Longoni³, Roberto Marchioli⁴, Massimo Tombesi², Gianni Tognoni¹, Maria Carla Roncaglioni¹, on behalf of the Collaborative Group Risk and Prevention Study*

¹Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy; ²CSeRMEG Centro Studi e Ricerca in Medicina Generale, Monza, Italy; ³CoS Consorzio Sanità, Milano, Italy; ⁴Consorzio Mario Negri Sud, S. Maria Imbaro, Italy *A full list of investigators is reported in the Appendix

Objectives: To assess the pharmacological treatment and the control of major modifiable cardiovascular risk factors in everyday practice according to the patients’ cardiovascular risk level.

Methods: In a cross-sectional study general practitioners (GPs) had to identify a random sample of their patients with cardiovascular risk factors or diseases and collect essential data on the pharmacological treatment and control of hypertension, hyperlipidemia, and diabetes according to the patients’ cardiovascular risk level and history of cardiovascular disease. Participants were subjects of both sexes, aged 40–80 years, with at least one known cardiovascular risk factor or a history of cardiovascular diseases.

Results: From June to December 2000, 162 Italian GPs enrolled 3120 of their patients (2470 hypertensives, 1373 hyperlipidemics, and 604 diabetics). Despite the positive association between the perceived level of global cardiovascular risk and lipid-lowering drug prescriptions in hyperlipidemic subjects (from 26% for lowest risk to 56% for highest risk p < 0.0001) or the prescription of combination therapy in hypertensives (from 41% to 70%, p < 0.0001) and diabetics (from 24% to 43%, p = 0.057), control was still inadequate in 48% of diabetics, 77% of hypertensives, and 85% of hyperlipidemics, with no increase in patients at highest risk. Trends for treatment and control were similar in patients with cardiovascular diseases.

Conclusions: Even in high-risk patients, despite a tendency towards more intensive treatment, pharmacological therapy is still under used and the degree of control of blood pressure, cholesterol level and diabetes is largely unsatisfactory.

Keywords: global cardiovascular risk, hypertension, hyperlipideamia, diabetes, general practice.