Which patients have the highest cardiovascular risk? A follow-up study from Turkey.
BACKGROUND
Recent guidelines target individuals at highest risk as a priority. However, implementation of guidelines even in this group is sub-optimal.


METHODS
A multicenter, observational follow-up study.


METHODS
A total of 5600 consecutive patients > or =55 year with high risk of vascular events were evaluated for risk factors and medication usage and followed for 1 year for primary end-points (death, myocardial infarction, stroke), and secondary end-points (revascularization, hospitalization).


RESULTS
The patients were divided into two groups: those without and with vascular disease. In the first group, mortality at 1 year was significantly higher in those with end organ damage (5.8 versus 2.7%, P=0.005). Similarly, the mortality in patients with known vascular disease (CAD, peripheral vascular disease, ischaemic stroke) was higher in the presence of a previous vascular event (7.8 versus 5.3%, P=0.055, vascular event: non-fatal MI/stroke). The use of antiplatelets, statins, beta-blockers and angiotensin-converting enzyme inhibitors was low and did not improve in the follow-up period. The most important predictors of cardiovascular mortality were the presence of end organ damage [odds ratio (OR) 1.65, P=0.001], pre-existing vascular disease (OR 1.49, P=0.023) and protectively, the consistent use of angiotensin-converting enzyme inhibitors (OR 0.49, P=0.001).


CONCLUSIONS
In a high-risk Turkish population, the early mortality and morbidity due to cardiovascular events was unacceptably high and medical treatment inadequate. The presence of end organ damage and a previous vascular event increased the risk even further and should be vigorously questioned. Aggressive lifestyle modification and medical therapy should be instituted in these patients.
Tokgözoğlu
Lale
L
Department of Cardiology, Hacettepe University, Ankara, Turkey.
Pehlivanoğlu
Seçkin
S
Kültürsay
Hakan
H
Oğuz
Aytekin
A
Damci
Taner
T
Senocak
Mustafa
M
Yusuf
Mehmet
M
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014421:Turkey
D000806:Angiotensin-Converting Enzyme Inhibitors