Revised guidelines for cardiovascular risk management — time to stop medication? A practice-based intervention study

Huug J van Duijn; Janneke N Belo; Jeanet W Blom; Irvine D Velberg; Willem JJ Assendelft

doi:10.3399/bjgp11X578025

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Figure 1
Flow chart of the study patients.

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Table 1

Data on included patients, attendance, low calculated cardiovascular risk, and advice to stop medication by practice

Practice	Included patients	Attendance, n (% of patients)	Low calculated risk n (% of attendance)	Advice to stop medication, n (% of low risk)
1	176	140 (79.5)	62 (44.3)	12 (19.4)

2	103	73 (70.9)	38 (52.1)	20 (52.6)

3	191	87 (45.5)	61 (70.1)	49 (80.3)

4	158	114 (72.2)	79 (69.3)	34 (43.0)

5	145	103 (71.0)	65 (63.1)	16 (24.6)

6	60	45 (75.0)	40 (88.9)	13 (32.5)

Total	833	562 (67.5)	345 (61.4)	144 (41.7)

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Table 2

Characteristics of the patients with a high risk and a low risk

	Female, n (%)	Age in years, mean (SD)	Smokers, n (%)	Comorbidity^a, n (%)	>2 Oral drugs, n (%)	>2 Oral cardiovascular drugs, n (%)	Cardiovascular disease in family, n (%)
High risk (n = 217)	105 (48.4)	64.5 (7.3)	55 (25.5)	113 (32.8)	142 (65.4)	32 (14.7)	123 (56.7)

Low risk (n = 345)	214 (62.0)	54.5 (8.5)	53 (15.4)	84 (38.7)	196 (56.8)	25 (7.2)	139 (40.3)

Advice to continue medication (n = 201)	122 (60.7)	55.4 (9.0)	38 (18.9)	74 (36.8)	112 (55.7)	14 (7.0)	81 (40.3)

Advice to stop medication (n = 144)	92 (63.9)	53.2 (7.7)	15 (10.4)	39 (27.1)	84 (58.3)	11 (7.6)	58 (40.3)

Still stopped after 6 months (n = 80)	50 (62.5)	51.8 (7.0)	6 (7.5)	23 (28.8)	21 (26.3)	1 (1.3)	33 (41.3)

Restarted within 6 months (n = 55)	36 (65.5)	53.9 (7.9)	8 (14.5)	13 (23.6)	16 (29.1)	7 (12.7)	23 (41.8)

Not stopped (n = 9)	6 (66.7)	58.7 (7.6)	1 (11.1)	3 (33.3)	4 (44.4)	3 (33.3)	2 (22.2)

SD = standard deviation.
↵a Asthma/chronic obstructive pulmonary disease (COPD), digestive, urogenital, psychosomatic, and/or musculoskeletal problems.

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Table 3

Final models for determinants of low cardiovascular risk and subsequent advice to stop medication: multivariate logistic regression analysis; adjusted odds ratio (95% confidence interval)

	Low cardiovascular risk (n = 562)	Advice to stop medication (n = 345)
Female sex	4.4 (2.7 to 7.3)	–^a

Age (continuous variable)	0.8 (0.8 to 0.8)	1.0 (0.9 to 1.0)

Non-smokers	4.0 (2.2 to 7.2)	2.5 (1.3 to 5.0)

More than two different oral drugs	0.6 (0.4 to 1.0)	–^a

Negative family history of cardiovascular risk	4.3 (2.7 to 7.1)	–^a