Integral control of risk factors in patients of high and very high cardiovascular risk in Spain.: CIFARC project

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the percentage of patients kith high and very high cardiovascular risk, with their risk factors globally well controlled (hypertension, dyslipemia, diabetes mellitus, tobacco and obesity). PATIENTS AND METHOD: Transversal study of ambulatory patients of internal medicine with an estimated cardiovascular risk high or very high (Framingham stratification scale over 20% in ten years). We evaluated the degree of control of their cardiovascular risk factors attending to the recommendations provided by recent international guidelines (WHO/ISH, JNC-VI, NCEP-ATP-III, ADA). RESULTS: We studied 2,264 patients (53.7% males; mean age: 66.1 +/- 11.5 years; 74.6% hypertensive, 61.1% dyslipidemic, 59.8% type 2 diabetes, 31.1% smokers, 38.0% obese and 36.7% in secondary prevention). Control of hypertension was achieved in 34.5%, dyslipidemia in 50.3% and diabetes in 35.5%. Global control of every risk factor was achieved in 6.9% (in 10.2% if we exclude obesity since it is not a risk factor used for cardiovascular stratification). Factors independently associated with a bad integral control were: diabetes (OR = 0.33; 95%Cl: 0.23-0.47), dyslipidemia (OR = 0.34; 95%CI: 0.24-0.48), proteinuria (OR = 0.36; 95%CI: 0.18-0.71). Factors independently associated with a better cardiovascular control were: male sex (OR = 1.67; 95%CI: 1.18-2.38), ventricular hypertrophy (OR = 1.62; 95%CI: 1.15-2.30) and the number of exploratory tests (OR 1.01; 95%CI: 1.01-1.08). CONCLUSIONS: Only 6.9% of patients with a high or very high cardiovascular risk have all their principal risk factors under control. The presence of diabetes, dyslipidemia or proteinuria predisposed to a worse control and the number of complementary tests performed to the patients was related to a better control.