title: High cardiovascular risk and poor adherence to guidelines in 11,069 patients of middle age and older in primary care centres.
abstract: BACKGROUND
  Evaluation of the risk for fatal cardiovascular (CV) disease and adherence to guidelines in ambulatory patients in primary care centres.
  
  
  METHODS
  Cross-sectional survey of risk factors and 10-year Systematic Coronary Risk Evaluation (SCORE) risk in 11,069 patients aged 50 years or more in primary care.
  
  
  RESULTS
  Three-thousand, seven hundred and thirteen (33.5%) patients were actual smokers. Although 61% of the patients were treated with at least one antihypertensive drug, the mean systolic blood pressure was 141±15 mmHg. Of the treated patients, only 15.9% were at goal. Thirty-six percent of the patients were perceived as normocholesterolemic by the primary care physician. In the group of patients, presumed as hypercholesterolemic, the total cholesterol level was 235±38 mg/dl, suggesting that only very high cholesterol level was considered relevant by physicians. Virtually 0% of the patients (n=2) were treated correctly. Obesity (body mass index >30 kg/m) was found in 41% of the patients and central obesity was found in 50% of the patients. Diabetes was present in 2085 (19%) patients and at least one earlier vascular event was present in 2913 (26.3%) patients, with combined pathologies in 388 (4.5%) patients. In the remaining 6766 (61%) patients (neither diabetes nor earlier CV event), the 10-year fatal CV risk according to the Belgian SCORE table was calculated as follows: 716 (10.6%) patients had a risk of less than 2%; 1680 (24.8%) patients had a risk of 2-4%; 2576 (38%) patients had a risk of 5-9% and 1794 (26.6%) patients had a risk of 10% or more.
  
  
  CONCLUSIONS
  Despite simple, clear, credible guidelines, despite the existence of a simple tool such as SCORE risk scoring and despite a very accessible health system in Belgium, the CV risk remains very high even in a professional medical environment of daily primary care practice.
authors.affiliation: Department of Cardiology, St Jan Hospital, Bruges, Belgium. luc.missault@azbrugge.be
authors.forename: Luc
authors.initials: L
authors.lastname: Missault
authors.forename: Nadine
authors.initials: N
authors.lastname: Witters
authors.forename: Johan
authors.initials: J
authors.lastname: Imschoot
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001530:Belgium; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016540:Smoking Cessation
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors