How much protected? Assessment of cardiovascular risk factors in patients with previous cardiovascular events admitted for acute coronary syndrome

Background The 2021 ESC guidelines on cardiovascular disease prevention recommend that all patients with a prior history of atherosclerotic cardiovascular disease (ASCVD) - with a history of acute coronary syndromes, coronary heart disease, surgical or percutaneous myocardial revascularization, stroke or peripheral arterial disease - are considered to have very high risk of cardiovascular events (class I, level A evidence). Despite having an increased residual risk, optimization and control of cardiovascular risk factors (diabetes, dyslipidemia, high blood pressure and smoking) is often suboptimal. Purpose The aim of this study is to evaluate the control of modifiable cardiovascular risk factors in patients with history of cardiovascular disease and admitted for acute coronary syndrome. Furthermore, understand the impact of follow-up in primary care (vs hospital follow-up) on this control. Methods We retrospectively evaluated patients admitted for acute coronary syndrome between November 2021 and October 2022 with history of cardiovascular disease, with or without hospital follow-up. Previous control of the main cardiovascular risk factors was assessed, as well as compliance with other secondary prevention measures (smoking abstinence, compliance with antithrombotic therapy). Results Between November 2021 and October 2022, 395 patients were admitted to our center due to acute coronary syndrome. 111 (30%) had a previous history of cardiovascular events, and of these, 41 (37%) remained under hospital follow-up. 66 patients (59%) were taking statins, but only 15 (14%) had LDL cholesterol levels <55 mg/dl and 28 (25%) LDL-C <70 mg/dl. 41 patients (37%) were diabetic, but only 35 (85%) had a previous known diagnosis and 12 (29%) were under control (HbA1c <7.0%). 97 patients (87%) had high blood pressure and 91 had systolic BP values >135 mmHg (82%). 33 patients (30%) were former smokers but 20 (18%) maintained smoking habits. 26 patients (23%) were obese (BMI >30 kg/m2). 28 patients (25%) were not taking any antithrombotic therapy. The adherence to statins was higher in patients that kept hospital follow up (50% in primary care vs 76% in hospital follow-up; p = 0.008) with no diferences regarding other risk factos. Conclusions Patients with established cardiovascular disease are a subgroup at high risk of recurrent events. Despite this, compliance with control measures is often suboptimal. It's urgent to establish multidisciplinar care programs in order to reduce their residual risk.