Adherence to guidelines to prevent cardiovascular diseases: The LifeLines cohort study

作者：Balder J W; Scholtens S; de Vries J K; van Schie L M; Boekholdt S M; Hovingh G K; Kamphuisen P W; Kuivenhoven J A^*

来源：Netherlands Journal of Medicine, 2015, 73(7): 316-323.

• Cardiovascular risk
• primary prevention
• secondary prevention
• statins
• undertreatment
• underuse
• risk assessment

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. While there is indisputable evidence that statin treatment reduces the burden of CVD, undertreatment remains a concern for primary and secondary prevention. The aim of this study was to assess the use of lipid-lowering drugs (LLD) among 70,292 individuals in the Netherlands as a proxy of adherence to the national guideline for prevention and treatment of CVD.
Methods: LifeLines is a population-based prospective cohort study in the three Northern provinces of the Netherlands. At baseline, all participants completed questionnaires, and underwent a physical examination and lab testing. The national guidelines were used to assess how many participants were eligible for LLD prescription and we analysed how many indeed reported LLD use.
Results: For primary prevention, 77% (2515 of 3268) of those eligible for LLD treatment did not report using these drugs, while for secondary prevention this was 31% (403 of 1302). Patients with diabetes mellitus were treated best (67%) for primary prevention. Notably, of the patients with stroke, only 47% (182 of 386) reported LLD treatment.
Conclusion: Despite clear guidelines and multiple national initiatives to improve CVD risk management, adherence to guidelines for the treatment of CVD in the Netherlands remains a major challenge. This study calls out for improving public awareness of CVD and to improve primary and secondary prevention to prevent unnecessary CVD-related morbidity and mortality.

• 出版日期2015-8