Turk Kardiyol Dern Ars. 1999; 27(8): 527-542

Estimated 44% Relative Cardiovascular Event Risk Reduction Achieved in the Multicenter Riskload Study, Implemented Along the Coronary Prevention Guidelines

Altan ONAT¹

A multicenter study comprising 26 medical units was carried out 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. Results obtained in 2021 enrolled volunteers over a total follow-up of 1245 patients-years among whom 970 individuals w ere followed up for 12 months are herein reported. Inclusion criteria postulated a minimum of 20-40% cardiovascular event risk in the subsequent 1 O years as estimated from the risk tab le of the ESC Guidelines. Allowance was made for the presence of symptomatic CHD, family history of premature coronary disease, diabetes, low HDLcholesterol (HDL-C) and high triglyceride levels. The number of individuals involved in primary and secondary prevention as well as of men and women were, by coincidence, 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 endpoint, and its determinants were analyzed. In the statistical evaluation, Wilcoxon and Mann-Whitney U tests were used to test the significance of the difference in the distribution of risk categories at baseline and at the end of 12 months. In addition, Framingham risk scores, computed from the data of each individual, served to assess the mean reduction in coronary risk. Mean global risk burden, 25.4% at baseline, diminished in absolute terms by 6.5% at 3 months, by 9.4% at six months and by ı 1.7% at 12 months; the tatter represents a relative risk reduction by 44% which exceeds by half as much the mean relative risk reduction obtained in 5 randomized lipid lowering trials - an achievement that seems plausible by the multilaterality of the preventive measures. The risk reduction was accompanied by a fall in the !eve! of risk factors persisring into the second 6- month period. Independent variables determining the ( enhanced) reduction in risk Jevel at the en d of ı 2 months w ere: 1) (high) level of baseline risk, 2) (high) degree of compliance with the treatment, 3) absence of a) CHD, b) diabetes and c) lipid lowering treatment, 4) younger age, 5) female gender, and 6) presence of smoking or of hypertension, 7) (high) level of baseline HDL-C. At the end of the study, women exhibited a higher reduction in cardiovascular risk than men, and while the reduction in patients with CHD amounted to 10.1% and 43.7% in absolute and relative terms, respectively, a reduction by 13.2% (p <0.001) and 46% (p <0.00 1) was obtained in the setting of primary prevention. The risk reduction was more prominent in smokers than in nonsmokers. Diabetes emerged as a factor modestly limiting the extent of risk reduction. Whereas subjects without hypertension, the most prevalent risk factor in this cohort, revealed a decline of coronary risk by merely 8.7%, those with hypertension showed a decline by 12.7% (p <0.001). No significant difference in global risk reduction was elicited between those not requiring lipid lowering treatment, as compared to persons subjected to such a treatment. These risk reductionsat the end of the study were accompanied by a diminution of mean LDL-C !eve! by 25.4%, a rise in mean HDL-C level by 16%, a fall in mean systolic blood pressure by 26 mmHg. Half of all smokers succeded in discontinuing the habit. In conclusion, by implementing standard prevention guidelines in the Turkish population, among each 1000 individuals comprising equal numbers of highrisk men and women and patients with CHD, prevention of cardiovascular events could be expected in 117 persons in the following ten years.

Keywords: Cardovascular event risk, coronary risk reduction, guidelines, implementation of prevention guidelines, optimal treatment, preventive cardiology

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