Cardiovascular risk factor control after implementation of mandatory risk assessment in a tertiary cardiovascular centre

Background Structured cardiovascular (CV) risk assessment is recommended by ESC guidelines to guide individualized preventive therapy. However, real-world data reveal a dual gap: suboptimal treatment intensification, especially in lipid management, and inconsistent implementation of CV risk assessment in routine practice. Moreover, data on early risk factor control at discharge following mandatory risk documentation remain limited. Purpose To evaluate LDL-cholesterol (LDL-C) and blood pressure (BP) control at hospital discharge following implementation of mandatory CV risk assessment. Methods This retrospective study included 5,982 hospitalized patients after introduction of mandatory CV risk documentation. Risk stratification was performed using SCORE2/SCORE2-OP or guideline-defined categories for patients with established cardiovascular disease. Discharge LDL-C and BP values, along with patient demographics, comorbidities and traditional risk factors, were analysed. Results Among a total of 5,982 patients (mean age 65.58±12.71; 65.14% male, 40.05% <65 years), 97.58% had calculated cardiovascular risk, with most classified as very high risk (76.65%). Common comorbidities included hypertension (86.94%), diabetes mellitus (23.00%), hyperlipidaemia (46.64%) and smoking (32.86%). At discharge, 84.08% of patients failed to achieve LDL-C targets, while 18.95% remained above blood pressure targets. Overweight/obese patients (71.47%) were less likely to achieve LDL-C targets compared to non-obese patients (15.03% vs 18.15%; p=0.003), while no association was found between BMI and BP (p=0.16). Younger patients (<65 years) achieved LDL-C targets more frequently than older patients (18.89% vs 13.93%; p<0.001). Similarly, BP control was more often achieved in younger compared with older patients (82.57% vs 80.03%; p=0.015) and in men compared with women (81.98% vs 79.31%; p=0.013). Conclusions LDL-C target achievement at discharge remains markedly suboptimal. In contrast, the high discharge BP control rate substantially overestimates true outpatient BP regulation. Younger patients demonstrated consistently better risk factor control, with modest gender differences in BP achievement. These findings underscore the need for earlier and more intensive lipid-lowering strategies, particularly in older high-risk individuals, and highlight the importance of optimizing preventive care immediately after hospitalization.