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To examine the extent of risk factor (RF) assessment in primary care (PC) in the 5 years preceding de novo presentation with premature coronary artery disease (CAD) in Wales and to assess utility of the Framingham 10-year cardiovascular disease risk score (CVDRS) to identify high-risk individuals.
We accessed records for 3,640,131 residents <65 years of age stored on the Secure Anonymised Information Linkage (SAIL) database. De novo ICD-10 secondary care diagnoses of CAD were identified for men aged <55 and women <65 years between 1. Jan. 2006 – 1. Dec. 2011. Linked PC datasets were accessed to note whether conventional RFs were recorded and CVDRS documented in the 5-years prior to index event. We also calculated CVDRS risk, post-hoc where possible.
De novo premature CAD was diagnosed in 13,060 individuals (60%M/40%W) in the study period. No CVD RFs documented in PC record in 5% (n=656). Diabetes was identified in 13%, of whom 61% had plasma glucose levels recorded (>7mmol/L=81%), and 78% had a Hb1Ac recorded (>6.5%=84%). In those without diabetes (87% n=11,571), blood pressure (BP) was recorded in 91% (SBP>140 +/- DBP>90mmHg=87%); total cholesterol in 75% (>5mmol/L=54% and >6.5mmol/L=32%); full lipid profile in 62%; smoking status in 92% (28% current; 19% quit ≥2y); body mass index (BMI) in 74% (BMI 25-≤30kg/m2=12% and BMI>30kg/m2=60%). Family history of premature CAD in a first-degree relative was recorded in 26%, of whom 16% had a positive family history. CVDRS was recorded in only 7% of PC records (of whom 11% had CVDRS≥20%). We could calculate CVDRS in 47% and 60% of males (M) and females (F) respectively of whom 29%/65% (M/F) were at ‘low risk’ (<10%), 44%/19% at ‘intermediate risk’ (10-<20%); and 27%/16% ‘high risk’ (≥20% or diabetic).
Significant gaps exist in extent of RF management for primary prevention of premature CAD in Wales. Of those developing CAD, CVDRS was rarely documented and about a half could have this calculated. Only a quarter of M and 1 in 6 F developing premature CAD would be considered ‘high risk’ at the time of prior risk assessment. More timely and thorough RF evaluation and better predictive models are needed to reduce the burden of premature CAD.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Risk Assessment in Primary Prevention
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1232M-11
- 2013 American College of Cardiology Foundation