Underutilisation of cardiovascular medications among at-risk individuals

Int J Clin Pract. 2010 Apr;64(5):604-10. doi: 10.1111/j.1742-1241.2009.02258.x. Epub 2009 Nov 11.


Aims: Guidelines recommend antihypertensive, lipid-lowering and/or antiplatelet therapy for prevention of cardiovascular disease (CVD). This study examined the utilisation of cardiovascular therapies among individuals at CVD risk to assess adherence to guidelines.

Methods: Respondents to the SHIELD study were classified based on National Cholesterol Education Program Adult Treatment Panel III risk categories. High coronary heart disease (CHD) risk (n = 7510) was defined as self-reported diagnosis of heart disease/heart attack, narrow or blocked arteries, stroke or diabetes; moderate risk (n = 4823) included respondents with > or = 2 risk factors (i.e., men > 45 years, women > 55 years, hypertension, low high-density lipoprotein cholesterol, smoking and family history of CHD); and low risk (n = 5307) was 0-1 risk factor. Respondents reporting a myocardial infarction, stroke or revascularisation at baseline (prior CVD event) (n = 3777), those reporting a new CVD event during 2 years of follow up (n = 953), and those with type 2 diabetes mellitus (n = 3937) were evaluated. The proportion of respondents reporting treatment with lipid-lowering, antiplatelet or antihypertensive agents was calculated.

Results: Utilisation of lipid-lowering therapy was low (< or = 25%) in each group. Prescription antithrombotic therapy was minimal among respondents with prior CVD events, but 47% received antihypertensive medication. No use before or after a new CVD event was reported by 36% of respondents for lipid-lowering, 32% for antithrombotic and > 50% for antihypertensive medications.

Conclusions: More than 50% of at-risk respondents and > 33% of respondents with new CVD events were not taking CVD therapy as recommended by guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use*
  • Cardiovascular Diseases / prevention & control*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data
  • Practice Guidelines as Topic
  • Prescription Drugs / therapeutic use
  • Risk Factors


  • Antihypertensive Agents
  • Fibrinolytic Agents
  • Hypolipidemic Agents
  • Prescription Drugs