Managing multiple cardiovascular risk factors

Journal of Family Practice,  March, 2008  by Roy C. Blank,  Stephen Brunton

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Family physicians can improve adherence to therapy through regular patient monitoring and patient education. Potential interventions include one-on-one discussions, written materials, telephone follow-up, and group sessions. (30) In addition, the use of combination products can reduce pill burden and improve adherence. Bangalore et al found that, compared with free-drug combination regimens, fixed-dose combinations resulted in a 26% decrease in the risk of patient noncompliance. (31) Other suggestions include prescribing medications with limited potential for side effects, prescribing drugs that can be taken once daily, and improving patient access to support staff to report or discuss concerns. (30)

The family physician and the patient must work together to reduce the patient's risk of CVD. Asking simple questions routinely about CVD risk factors can promote patient awareness and adherence to lifestyle choices. Office staff can aid in CVD risk reduction efforts by administering simple risk questionnaires. The use of such risk assessment questionnaires as well as patient flow sheets can allow a primary care practice to improve CVD risk reduction strategies. Patient support resources are also available on the Internet and in your community.

Conclusion

The importance of risk factor assessment cannot be overestimated. Addressing all modifiable risk factors that are identified in a given patient is vitally important. Monitoring the patient and modifying therapy, as required, to achieve and maintain treatment goals must be done on an ongoing basis and must take into account the impact of treatment choices on patient adherence. The unique relationship between the primary care physician and the patient provides an opportunity for the physician to have a positive impact on the patient's CV outcome.

Key Points and Recommendations

* When determining a treatment plan to reduce CVD risk, treat risk factors concomitantly rather than sequentially, thereby providing the greatest impact on overall CVD risk. This is particularly important because risk factors for CVD tend to cluster and interact in individuals, which exerts a greater combined risk.

* Simplify treatment plans to increase patient compliance.

* Individualize risk assessment and the subsequent treatment plan for each patient, targeting the lower end of treatment goal ranges. This is important because even if the number of individual risk factors is only moderate, the collective impact of multiple risk factors is intensified.

* Treatment of CVD risk factors should include such lifestyle changes as smoking cessation, dietary modification, and increased physical activity, as well as pharmacotherapy, when indicated.

Disclosures

Editorial support for the development of this supplement was provided by The Primary Care Education Consortium (PCEC) and funded by Pfizer Inc. Dr Blank and Dr Brunton each received an honorarium from PCEC in connection with the development of this supplement. Dr Brunton is on advisory boards for Amylin Pharmaceuticals, Inc., Novo Nordisk, and Pfizer Inc. Dr Blank reports that he has received grant or research support from Takeda Pharmaceuticals, Merck & Co., Inc, and Pfizer Inc.