Real- life cardiovascular risk profiles in a mixed rural- urban romanian community- insights from primary care

Abstract Background/Introduction Primary care plays a central role in cardiovascular (CV) disease prevention. Increasingly, family physicians acknowledge their pivotal role in early identification and management of modifiable CV risk factors and implement structured prevention programs. Real-world evidence from primary care offices remains limited for Eastern Europe. Purpose To assess the prevalence of major CV risk factors and estimate ten-year CV risk in middle-aged adults attending a primary care practice. Methods This prospective cross-sectional study included 130 adults aged 40 - 65 years who visited their family physician between January and April 2025. Data collection included demographic characteristics, medical history, anthropometric measurements, and laboratory parameters. Lifestyle characteristics - including physical activity, psychosocial status, and Mediterranean diet adherence - were evaluated using standardised questionnaires. Participants were grouped as apparently healthy, diabetic or with known atherosclerotic disease (ASCVD). Ten-year CV risk was estimated using SCORE 2, SCORE 2 Diabetes, or SMART charts. Statistical analyses used ANOVA, Mann-Whitney U, Chi-square tests, and Spearman correlation. Results Mean age was 53 years ±6.9 years; 63% were women and 56% resided in urban area. Obesity was highly prevalent (79.2%) with increased waist circumference in 83% of males and 90% of women. Arterial hypertension was present in 76.9% of participants, smoking in 44.6% and diabetes in 16.9% Elevated total and LDL cholesterol levels were common across all subgroups, including those with documented ASCVD (mean LDL-C: 127.5 mg/dl in chronic coronary syndrome, 144.5 mg/dl in peripheral artery disease, 116.58 mg/dl in patients with stroke, 141.28 mg/dl in diabetics. HbA1c measurements were available in 14 of 22 diabetic patients, with a mean of 6.61% (range 4.98-9.4%). Regarding lifestyle, 33.9% reported moderate physical activity and 26.9% high activity; 50.0% individuals obtained a high Mediterranean diet score (between 8-14 points). Insomnia affected 48.0% of participants. Ten-year CV risk was calculated in 110 participants with available data: 34.5% were at very high risk and 43.6% at high risk, irrespective of the chart used. Mean risk estimates were: SCORE 2, 8.5%; SCORE 2 diabetes, 13.6%; SMART, 21.8%. Rural patients had higher waist circumference (p=0.0068), higher BMI (p=0.0017), and lower activity levels (p=0.0443). CV risk factor burden significantly increased with age and men exhibited a less favourable metabolic profile. Conclusion This real-world analysis shows a high burden of CV risk factors and elevated ten-year CV risk among middle-aged individuals attending a primary care practice in Romania. Despite clear guideline recommendations, most individuals presented with an unfavourable cardiometabolic profile, highlighting the need to strengthen preventive strategies in primary care, particularly in rural settings.