Risk factor control prior to first cardiovascular event in Oxfordshire,UK 2002-2012 (oxford vascular study): adequacy, determinants and time-trends

Abstract

Cardiovascular disease(CVD) is the commonest cause of death and disability worldwide. Prevention of CVD largely depend on optimal risk factor control. Yet risk factor control in asymptomatic general population is reported grossly inadequate. However, population based data on premorbid risk factor control among patients who experienced incident CVDs are lacking. Furthermore comparative data of premorbid risk factor profiles of different CVD types in the same population is not available. Therefore,the aim of this thesis, is to study the adequacy, determinants and time-trends of premorbid risk factor control of all acute incident CVDs in a population based cohort to understand reasons behind failure in primary prevention. All prospectively r5cruited acute incident CVDs that occurred between 2002-2012 of nine general practice areas in Oxfordshire, UK (Oxford Vascular Study) were studied. Data on risk factors and premorbid medications were collected from face-to-face interviews and primary-care and hospital records Adequacy of risk factor control and premorbid medication use were studied against predicted 10-year general cardiovascular-risk calculated using Framingham general cardiovascular-risk model at incident event. Determinants of risk factor control were studied using logistic regression. Time trends in risk factor control and premorbid medication use were studied in 2-year time bands. 3145 acute incident CVDs; 1154-coronary artery diseases(CAD) 250-peripheral arterial diseases(P AD) and 1741-cerebrovascular events(CVE) were studied. Prevalences of hypertension, hypercholesterolaemia, diabetes-mellitus, obesity and current-smokers were 56 6% 23.9% 13.2%, 20.4% and 20 0% respectively 82 1% and 51.8% of pre-diagnosed patients with hypertension and hyperlipidaemia were on medications. However only 27.0% and 60 7% of treated hypertensive and hyperlipidaemia patients had achieved treatment goals. 78.5% and 92.2% of them remained at high CV-risk due to poorly-controlled concomitant risk factors. Further, cardiovascular risk factors showed specific differential associations to different vascular events. Prevalence of hyperlipidaemia diabetes mellitus and BMI2:25kg/m2 increased over time. Premorbid antihypertensive and lipid-lowering medication use also increased while premorbid antiplatelet medication use declined.

In conclusion, failure of primary prevention of CVDs lies at poor achievement of treatment goals rather than at under-treatment of risk factors. The findings emphasise the importance of tailored-guidelines and treating all risk factors to achieve treatment goals in prevention of cardiovascular diseases