Real-world Cardiovascular Risk Estimation, Blood Pressure and LDL-Cholesterol Control: Two Epidemiological Studies in Romania, during pandemic and post-pandemic (SNAPSHOT-Romania)

Background and aims Data on estimation of cardiovascular (CV) risk by physicians and perceptions of hypertension and dyslipidemia control are lacking in Eastern Europe. Therefore, in patients with hypertension and dyslipidemia, during the COVID-19 pandemic and post-pandemic periods, we compared CV risk, blood pressure (BP) and low-density lipoprotein-cholesterol (LDL-C) control, as assessed by physicians, with the recommendations of the European guidelines. Methods Two observational, cross-sectional, epidemiological studies with similar designs were conducted in Romania during the pandemic (SNAPSHOT-1, June 2021) and post-pandemic (SNAPSHOT-2, June 2022). Results We included 5,004 patients with hypertension and dyslipidemia: 2,469 in SNAPSHOT-1 and 2,535 in SNAPSHOT-2. In SNAPSHOT-1, the CV risk estimated by investigators was “high” or “very high” for 34.3% and 35.4% of patients, respectively, whereas the CV risk based on guidelines recommendations was “high” or “very high” for 12.6% and 81.8% of patients; 41.5% of investigators estimated the CV risk accurately, whereas 54.2% underestimated it. BP and LDL-C were considered to be controlled by investigators in 71.2% and 46.1% of patients, respectively, whereas control rates based on guideline recommendations were achieved in 25.0% and 8.8% of patients. Both targets were considered controlled together by investigators in 39.6% of patients versus 3.3% based on guideline recommendations. The SNAPSHOT-2 results were similar. Conclusions SNAPSHOT studies have shown that the estimation of CV risk by physicians is accurate in fewer than half of patients, being markedly underestimated. BP and LDL-C control is overestimated by physicians, whereas control rates, as recommended by the guidelines, are very low. The results were similar when a similar population was assessed during the COVID-19 pandemic and post-pandemic.