How to improve primary prevention in asymptomatic high risk subjects

Aims Description of cardiovascular risk factor distribution in a primary prevention centre in a cohort of 2142 consecutive high-risk patients and proposal for improving cardiovascular prognosis by combination of risk score and carotid intima media thickness (IMT) measure. Methods and results Two thousand one hundred and forty-two high risk patients including 59.3% men (mean age 51.4 years for men, 55.8 years for women) with an average of 4.7 risk factors/pt were enrolled. All of these patients were referred for clinical examination, biological measurements, stress test, carotid, abdominal aorta and femoral ultrasonography with intima media thickness measurement. Distribution of risk factors is as follows: family history of premature cardiovascular disease (CVD) 39.8%, hypertension 23.5%, dyslipidaemia 49.5%, hyperglycaemia 10.6%, overweight 46.7,%, current tobacco smoking 16%, sedentarity 29%. However, treatments targets were reached for only 25% of hypertensive patients, 16.2% for dyslipidaemic patients and 6.8% for patients with hyperglycaemia. This study con.rms the gap between scientific knowledge and current practice. Among patients aged ≤60; 16.8% have a high global 5-year risk score (Framingham) but sub-clinical arterial lesions are found in 59.3% of them. Conclusions In current clinical practice, this study suggests that combination of global risk score with ultrasonography may contribute to better identify high-risk patients and motivate them for cardiovascular prevention. The discovery of vascular damages will lead to an intensive therapeutic strategy even if the risk score seems to be reassuring.