Estimated Relative Cardiovascular Event Risk Reduction by 38%: Interim Results of the Multicenter Riskload Study, Implementing the Coronary Prevention Guidelines

A multicenter study comprising 26 medical units was initiated in Turkey with the purpose of assessing the feasibility and extent of risk reduction in cardiovascular events upon implementation of the Turkish Guidelines on Prevention of Coronary Heart Disease, based on those of NCEP and the European Society of Cardiology (ESC), in patients with coronary heart disease (CHD) or those at high risk for it in the setting of elinical practice. This interim report concems results obtained in 889 individuals followed up for 3 months and 437 subjects for 6 months out of the total enrolled 1930 volunteers. lnelusion criteria postulated a minimum of 20-40% cardiovascular event risk in the subsequent 10 years as estimated from the risk table of the ESC Guidelines. Allowance was made for the presence of symptomatic CHD, family history of premature coronary disease, diabetes, low HDL-cholesterol (HDL-C) and high triglyceride levels. As a coincidence, the number of individuals involved in primary and secondary prevention as well as of men and women were virtually identical. Laboratory tests were performed at each center. The estimated CHD risk reduction as evaluated from the risk tables of the ESC Guidelines constituted the primary end-point, and its determinants were analyzed. In the statistical evaluation, Wilcoxon and Mann-Whitney U tes ts w ere u sed to test the significance of the difference in the distribution of risk categories at baseline and at the end of 3 and 6 months, respectively. In addition, Framingham risk scores, computed from the data of each individual, served to assess the mean reduction in coronary risk. Canceming the primary end-point, mean global risk load, 26% at baseline, diminished in absolute terms by 7% at 3 months and by 10% at six months; the latter represents a relative risk reduction by 38%. This was accompanied by a fall in the level of risk factor persisting in the second 3-month period. Independent variables determining the (enhanced) reduction in risk categories at the end of 6 months were: 1) (high) degree of compliance w ith the treatment, 2) absence of CHD, 3) female gender, and 4) (high) level of baseline HDL-C. At the end of six months, women exhibited a higher reduction in cardiovascular risk than men. While the risk reduction at the second and third visits in patients with CHD amounted to 6% an 8%, respectively, a reduction by 8% (pKeywords: Cardiovascular event risk, coronary risk reduction, guidelines, implementation of prevention guidelines, optimal treatment, preventive cardiology