Secondary prevention of CVD in Italy ‘suboptimal’
MedWire News: A survey of Italian cardiovascular disease (CVD) patients has identified shortfalls in the implementation of secondary prevention measures, including lifestyle modification and lipid control.
The "disappointing" findings underscore the need for greater efforts by physicians to implement clinical guidelines and reduce the burden of cardiovascular disease, say the study authors.
The survey was conducted among a representative cross-section of Italian cardiology outpatients. In all, 878 consecutive patients at 49 outpatient clinics were assessed; all had suffered a cardiovascular event requiring hospitalization 12-24 months earlier.
The patients' mean age was 64.9 years, 78% were male, 26% had diabetes mellitus, and the median time from index event to interview was 17.7 months. The most frequent reasons for admission were acute coronary syndromes, percutaneous coronary intervention, and coronary artery bypass graft surgery.
Encouragingly, 32% of the participants had been cigarette smokers at the time of their index event but just 13% were smokers at follow-up.
However, 21% of patients had uncontrolled blood pressure at follow-up, while 33% reported being completely physically inactive. Of 78% of patients who received dietary counseling at discharge, just 49% were following a "healthy dietary lifestyle" at the time of interview and just 30% had a normal body mass index.
In terms of medication, 91% of patients were taking statins at follow-up, but just 73% had had low-density lipoprotein (LDL) cholesterol levels measured in the previous 6 months. Of those with a recent LDL cholesterol measurement, 43% had levels above 100 mg/dl (2.59 mmol/l) and 80% had levels above 70 mg/dl (1.81 mmol/l).
Pasquale Perrone-Filardi (Federico II University of Naples) and team say that their study "largely confirms, on a national basis, the suboptimal control of major risk factors for cardiovascular disease… and reinforce the great concern regarding lack of appropriate implementation of current guidelines for secondary prevention in a large European country."
They conclude: "In consideration of the major role that healthy lifestyle plays in the prevention of cardiovascular disease, these data are particularly disappointing and call for intensification of advertising campaigns among patients with established coronary artery disease and increased cardiovascular risk."
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By Joanna Lyford