Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: Data from the contemporary CLARIFY registry

Eur J Prev Cardiol. 2015 Aug;22(8):1056-65. doi: 10.1177/2047487314547652. Epub 2014 Aug 21.


Aim: To determine the current prevalence and control of major cardiovascular risk factors in stable CAD outpatients worldwide.

Methods: We analysed variations in cardiovascular risk factors in stable CAD outpatients from CLARIFY, a 5-year observational longitudinal cohort study, in seven geographical zones (Western/Central Europe; Canada/South Africa/Australia/UK; Eastern Europe; Central/South America; Middle East; East Asia; and India).

Results: Patient presentation (N=32,954, mean age 64.2 years, 78% male) varied between zones, as did prevalence of risk factors (all p < 0.0001). Obesity ranged from 20% (East Asia) to 42% (Middle East), raised blood pressure from 28% (Central/South America and East Asia) to 48% (Eastern Europe), raised LDL cholesterol from 24% (Canada/South Africa/Australia/UK) to 65% (Eastern Europe), elevated heart rate (≥70 bpm) from 38% (Western/Central Europe) to 78% (India), diabetes from 17% (Eastern Europe) to 60% (Middle East), and smoking from 6% (Central/South America) to 19% (Eastern Europe). Aspirin and lipid-lowering drugs were widely used everywhere (≥84% and ≥88%, respectively). Rates of risk factor control varied geographically (all p < 0.0001). Rate of controlled blood pressure in hypertension varied from 47% (Eastern Europe) to 66% (Central/South America), glucose control in diabetes from 23% (India) to 51% (Western/Central Europe and East Asia), controlled LDL cholesterol and dyslipidaemia from 32% (Eastern Europe) to 75% (Canada/South Africa/Australia/UK), heart rate <70 bpm from 22% (India) to 62% (Western/Central Europe), and heart rate ≤60 bpm in angina patients from 2% (India) to 29% (Canada/South Africa/Australia/UK and Central/South America).

Conclusion: Prevalence and control of major cardiovascular risk factors in stable CAD vary markedly worldwide. Many stable CAD outpatients are being treated suboptimally.

Keywords: CLARIFY; Stable CAD; cardiovascular risk factor; geographical variation.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa / epidemiology
  • Aged
  • Asia / epidemiology
  • Australia / epidemiology
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Cross-Sectional Studies
  • Europe / epidemiology
  • Female
  • Healthcare Disparities / trends*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Outpatients*
  • Practice Patterns, Physicians' / trends*
  • Prevalence
  • Registries
  • Residence Characteristics*
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior*
  • South America / epidemiology
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN43070564