Which patients have the highest cardiovascular risk? A follow-up study from Turkey

• Published in: European journal of cardiovascular prevention and rehabilitation 2005-06, Vol.12 (3), p.250-256
• Main Authors: Tokgözoğlu, Lale, Pehlivanoğlu, Seçkin, Kültürsay, Hakan, Oğuz, Aytekin, Damci, Taner, Şenocak, Mustafa, Yusuf, Mehmet
• Format: Article
• Language: English
• ISSN: 2047-4873; 1741-8267; 2047-4881; 1741-8275
• DOI: 10.1097/01.hjr.0000160723.97540.fd

Background Recent guidelines target individuals at highest risk as a priority. However, implementation of guidelines even in this group is sub-optimal. Design A multicenter, observational follow-up study. Methods A total of 5600 consecutive patients ≥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). Conclusion 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.