Determinants of poor control of risk factors in coronary patients in primary care

Introduction: The objective of secondary prevention of cardiovascular disease is to reduce the risk of a new cardiovascular event and increase survival. Patients in secondary prevention are at very high risk and represent the first priority in the prevention of cardiovascular disease. The aim of this study was to identify the determinants of poor control of risk factors in coronary patients attended in primary care. Methods: We performed a retrospective multicenter evaluation study with review of medical records and telephone calls to patients diagnosed with coronary heart disease attended in five primary care centers in the provinces of Barcelona and Gerona. Results: A total of 736 patients were studied, with a mean age of 72.11 years (71.4% were male). The following determinants of uncontrolled blood pressure (BP > 140/90 mmHg or BP > 130/80 mmHg in patients with diabetes mellitus or renal insufficiency) were identified: 1. Not being diagnosed with myocardial infarction (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.07-2.43); 2. Having a diagnosis of diabetes mellitus (OR = 4.26; 95% CI, 2.76-6.57): 3. Having a diagnosis of hypertension (OR = 2.67; 95% CI, 1.71-4.17), and 4. Not being diagnosed with chronic obstructive pulmonary disease (OR = 1.98; 95% CI, 1.01-3.89). The following determinants of poor lipid control (low-density lipoprotein cholesterol > 100 mg/dl) were identified: 1. Having a diagnosis of dyslipidemia (OR = 1.91; 95% CI, 1.21-3.03); 2. Not being diagnosed with hypertension (OR = 1.97; 95% CI, 1.23-3.14), and 3. Not being treated with statins or other lipid-lowering drugs (OR = 3.28; 95% CI, 1.78-6.06). Conclusions: Diabetes mellitus continues to be a major determinant of uncontrolled blood pressure and therefore antihypertensive therapy should be intensified in these patients. Lipid control could improve if new treatments were offered to patients not reaching therapeutic targets. (c) 2009 Elsevier Espana, S.L. and SEA. All rights reserved.