A comparison of primary versus secondary cardiovascular disease prevention in an academic family practice.

BACKGROUND The risk of mortality from cardiovascular disease (CVD) is much higher in those with preexisting CVD than in those without it. Risk factor modification can reduce these risks. This study was designed to determine whether physicians manage risk factors differently in patients with and without overt CVD. METHODS Risk factor identification and management strategies after the diagnosis of CVD (secondary prevention) were analyzed by chart audit for 61 patients with premature CVD and 61 age-matched patients free of CVD (primary prevention). All of these patients had entered an academic family practice within 1 year of each other and had at least two physician visits between 1982-1992. RESULTS In the majority of patients, risk factors for CVD were identified by family physicians. Few differences in counseling and management of risk factors were noted between patients with premature CVD and those free of CVD. Management of hypertension was performed with behavioral and pharmacologic therapy; more than 94% of the patients had at least one posttreatment blood pressure below 140/90. Lipid disorders, however, were managed primarily by diet; only 20% of cases with hyperlipidemia and premature CVD received pharmacologic therapy, and only 2.5% had a controlled blood cholesterol level (below 200 mg/dl). CONCLUSIONS In an academic family practice, CVD risk factor identification was high but recommended management practices in the secondary prevention of CVD were suboptimal. Management of CVD risk factors was not more aggressive among secondary prevention cases compared to primary prevention controls.