Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2023; 15(7): 342-353
Published online Jul 26, 2023. doi: 10.4330/wjc.v15.i7.342
Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention
Rahima Gabulova, Anna Marzà-Florensa, Uzeyir Rahimov, Mahluga Isayeva, Shahana Alasgarli, Afag Musayeva, Sona Gahramanova, Firdovsi Ibrahimov, Farid Aliyev, Galib Imanov, Rahmana Rasulova, Ilonca Vaartjes, Kerstin Klipstein-Grobusch, Ian Graham, Diederick E Grobbee
Rahima Gabulova, Sona Gahramanova, Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
Anna Marzà-Florensa, Ilonca Vaartjes, Kerstin Klipstein-Grobusch, Diederick E Grobbee, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
Uzeyir Rahimov, Department of Cardiology, Baku Medical Plaza, Baku AZ1014, Azerbaijan
Mahluga Isayeva, Department of CHD and Arrhythmias, Scientific-Research Institute of Cardiology, Baku AZ1072, Azerbaijan
Shahana Alasgarli, Firdovsi Ibrahimov, Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
Afag Musayeva, Farid Aliyev, Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
Galib Imanov, Teaching-Surgical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
Rahmana Rasulova, Department of Public Health, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
Ian Graham, Department of Cardiology, Trinity College Dublin, Dublin Dublin-2, Ireland
Author contributions: Gabulova R analyzed the data and wrote the manuscript; Marzà-Florensa A was involved in all stages of developing the final version of the manuscript; Rahimov U, Isayeva M, Alasgarli S, Musayeva A, Gahramanova S, Ibrahimov F, Aliyev F, and Imanov G collected the clinical data and contributed equally to this work; Rasulova R analyzed the data; Vaartjes I and Klipstein-Grobusch K critically reviewed the manuscript; Graham I and Grobbee DE designed the research study and critically reviewed the work; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Research Ethic Committee of The National Cardiac Society of Azerbaijan (No. 01/2022).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There is no conflict of interests to disclose. SURF II is conducted within the framework of the ESC Prevention of CVD Programme, led by the European Association of Preventive Cardiology (EAPC).
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rahima Gabulova, MD, PhD, FESC, Associate Professor, Teaching-Therapeutical Hospital, Azerbaijan Medical University, 100 Mardanov Brothers, Baku AZ1022, Azerbaijan. rahima.gabulova@gmail.com
Received: March 25, 2023
Peer-review started: March 25, 2023
First decision: June 1, 2023
Revised: June 14, 2023
Accepted: July 3, 2023
Article in press: July 3, 2023
Published online: July 26, 2023
Processing time: 121 Days and 16.6 Hours
Abstract
BACKGROUND

Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease (CVD). The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology (ESC). Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate. Azerbaijan is a country in the South Caucasus, a region at a very high risk for CVD.

AIM

To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku (Azerbaijan).

METHODS

Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021. Information on demographics, risk factors, physical and laboratory data, and medications was collected using a standard questionnaire in consecutive patients aged ≥ 18 years with established CHD during outpatient visits. Data from 687 patients (mean age 59.6 ± 9.58 years; 24.9% female) were included in the study.

RESULTS

Only 15.1% of participants were involved in cardiac rehabilitation programs. The rate of uncontrolled risk factors was high: Systolic blood pressure (BP) (SBP) (54.6%), low-density lipoprotein cholesterol (LDL-C) (86.8%), diabetes mellitus (DM) (60.6%), as well as overweight (66.6%) and obesity (25%). In addition, significant differences in the prevalence and control of some risk factors [smoking, body mass index (BMI), waist circumference, blood glucose (BG), and SBP] between female and male participants were found. The cardiovascular health index score (CHIS) was calculated from the six risk factors: Non- or ex-smoker, BMI < 25 kg/m2, moderate/vigorous physical activity, controlled BP (< 140/90 mmHg; 140/80 mmHg for patients with DM), controlled LDL-C (< 70 mg/dL), and controlled BG (glycohemoglobin < 7% or BG < 126 mg/dL). Good, intermediate, and poor categories of CHIS were identified in 6%, 58.3%, and 35.7% of patients, respectively (without statistical differences between female and male patients).

CONCLUSION

Implementation of the current ESC recommendations for CHD secondary prevention and, in particular, the control rate of BP, are insufficient. Given the fact that patients with different comorbid pathologies are at a very high risk, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at a high risk for CVD. A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

Keywords: Coronary heart disease; Cardiovascular risk factors; Secondary prevention; Clinical practice guidelines; Clinical audit; Survey of risk factors

Core Tip: The article stresses the value of audit studies in clinical practice. It confirms that the control rate of major cardiovascular risk factors is insufficient and stresses the importance of an individual approach to the secondary prevention of atherosclerotic coronary heart disease, considering patients' gender, comorbidities, cultural peculiarities, and the region of their residence.