Impact of mandatory cardiovascular risk assessment on risk factor control and prescribing patterns in a tertiary cardiovascular centre

Background Systematic cardiovascular (CV) risk assessment is central to guideline-directed prevention, yet its routine implementation in clinical practice remains inconsistent. Purpose To evaluate the impact of mandatory CV risk documentation on blood pressure (BP), LDL-cholesterol (LDL-C), and prescribing patterns in a tertiary cardiovascular centre. Methods This retrospective observational study included 14,667 hospitalized patients. Two periods were compared: before implementation of mandatory CV risk assessment (March 2024–March 2025; n=8,685) and after implementation (March 2025–December 2025; n=5,982). Risk stratification was performed using SCORE2/SCORE2-OP or guideline-defined categories for patients with established cardiovascular disease. Discharge BP, LDL-C levels, and prescription of fixed-dose combination therapies were analysed. Results The study population (mean age 65.6±12.4 years; 35.1% female) had a high prevalence of comorbidities and risk factors, including hypertension (65.7%), hyperlipidaemia (46.4%), diabetes (24.2%), atrial fibrillation (25.1%), heart failure (23.2%), and current smoking (34.3%), with a mean BMI of 28.0 ± 5.6 kg/m². Following implementation, modest but statistically significant reductions were observed in systolic BP (133.4±24.4 vs. 132.4±24.3 mmHg; p=0.014), diastolic BP (78.2±13.4 vs. 77.3±13.3 mmHg; p<0.001), and LDL-C (2.88±1.11 vs. 2.80±1.08 mmol/L; p=0.001). Use of fixed statin–ezetimibe combination therapy increased substantially (8.76% vs. 20.68%; p<0.001). In contrast, prescription rates of dual (17.27% vs. 16.83%; p=0.627) and triple (10.48% vs. 10.60%; p=0.730) antihypertensive fixed-dose combinations remained unchanged. Conclusions Implementation of mandatory CV risk documentation was associated with improved discharge LDL-C and BP levels and a marked increase in combination lipid-lowering therapy, suggesting enhanced alignment with guideline-directed prevention. However, antihypertensive prescribing patterns remained unchanged, indicating potential therapeutic inertia.This therapeutic gap raises concern for future deterioration of blood pressure control due to reduced adherence related to higher pill burden. Structured risk assessment may represent a practical strategy to improve implementation of preventive care in high-volume centres.