Achievement of Treatment Goals for Primary Prevention of Cardiovascular Disease in Clinical Practice Across Europe: The EURIKA Study

Study Questions:

Are primary prevention treatment goals met in clinical European practices?

Methods:

This was a cross-sectional study of primary prevention among outpatients, 50 years or older, from 12 European countries, with no clinical cardiovascular disease (CVD) at baseline. Patients had one or more CVD risk factors. Risk factor definitions and treatment goals were based on 2007 European guidelines on CVD prevention. Risk factors assessed included cholesterol including low-density lipoprotein (LDL) cholesterol, glycated hemoglobin, and blood pressure.

Results:

A total of 7,641 outpatients were included in the study (mean age 63 years, 48% men). CVD risk was categorized as high in 40.1% of the cohort. Among those treated for hypertension (94.2%), only 38.8% had controlled blood pressure defined as <140/90 mm Hg. Among patients receiving treatment for dyslipidemia (74.4%), only 41.2% attained both the total and LDL cholesterol targets of <5 and <3 mmol/L, respectively. Among treated type 2 diabetics (87.2%), only 36.7% achieved a goal glycated hemoglobin of <6.5%. Among obese patients on nonpharmacologic treatment (92.2%), only 24.7% reached a body mass index of <30 kg/m2. Overall, approximately one-third of controlled patients on treatment remained at high CVD risk. Most patients had received advice to reduce excess weight and follow a low-calorie diet; however, less than one-half had received written recommendations.

Conclusions:

The investigators concluded that a large number of patients in need of primary CVD prevention efforts were not well controlled. Lifestyle counseling was often not well implemented, and significant variation was observed between countries.

Perspective:

This study highlights the substantial room for improvement in primary prevention. Early diagnosis followed by prompt effective risk factor modification translates into risk reduction and reduction of CVD events.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Hypertension

Keywords: Life Style, Risk Reduction Behavior, Early Diagnosis, Body Weight, Counseling, Europe, Primary Prevention, Goals, Cholesterol, Caloric Restriction, Obesity, Hypertension


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