Heterogeneity among countries in primary cardiovascular prevention guidelines: missed opportunities for adherence and improved outcomes. (11th May 2022)

• Record Type: Journal Article
• Authors: Santilli, F; Blaha, MJ; Li, L; Li, X; Na, SH; Shi, Z
• Is Part Of: European journal of preventive cardiology. Volume 29(2022)Supplement 1
• Publication Date: 2022-05-11
• Subjects: Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1093/eurjpc/zwac056.136
• Languages: English
• ISSNs: 2047-4873

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: Private company. Main funding source(s): Bayer AG Background: · Specialty-driven guidelines identify risk factors for cardiovascular (CV) events that may potentially be modified by lifestyle or pharmacotherapy. Purpose: · Worldwide, the control of modifiable risk factors in people at high cardiovascular disease (CVD) risk remains poor. Our hypothesis is that differences in multiple, specialty-driven guidelines do not help, and may hinder, the accurate assessment of CV risk factors and their appropriate management in the individual patient that has multiple risk factors or comorbidities. Methods: · We conducted a review of the most recent guidelines for CVD prevention, diabetes, hypertension, dyslipidaemia and chronic kidney disease used in Europe, Italy, the USA, China and South Korea to establish the commonalities and differences between risk factor targets, risk modifiers and treatment approaches. Results: · The use of low dose aspirin in patients at high risk of CVD varies between regions, and between those with and without type 2 diabetes (T2D). In addition, the use of concomitant proton pump inhibitor (PPI) treatment, that may reduce the gastrointestinal bleeding risk and therefore allow more people to be included for low dose aspirin treatment consideration, is variable (see table). · There are also differences in the definitions of risk stratification, targets for major risk factors and the use of coronary artery calcium score (CAC) to identify high-risk, asymptomatic patients. · The LDL-C targets for patients with T2D at high CV risk vary from <1.8 mmol/L (<70 mg/dL)1, 2, 10 to <2.6 mmol/L (<100mg/dL);9 and those for patients with T2D at very high CV risk vary from <1.4 mmol/L (<55 mg/dL)1, 2 to <1.8 mmol/L (<70 mg/dL).9 · Although CAC score is identified as a risk modifier in most guidelines, its use to guide treatment decisions in patients with ≥7.5% to <20% 10-year ASCVD risk is recommended in only two guidelines.4, 6 Conclusion(s): · We suggest that physicians cannot synthesise specialty-based recommendations for a single patient with multiple comorbidities within a limited consultation time, and that this may be a major factor in the lack of progress in managing CV risk factors. · A more unified, consistent and global approach to primary prevention of CV disease across specialties may lead to greater guideline adherence, greater patient understanding and acceptance of therapy, and improved outcomes.