AN ASSESSMENT OF THE PRIMARY PREVENTION CONTROL PROGRAM OF PHC PREVENTIVE CARDIOLOGY CLINIC AMONG PATIENTS AT RISK FOR CVD: A Retrospective Cohort Study Preventive Cardiology Division, Philippine Heart Center

INTRODUCTION According to Global Burden of Disease Study estimate, CVD accounted for 10% of global disease burden, with a projected rise to almost 15% by Cardiovascular disease is the single most common cause of death in the world. Risk factor management should be thought of as prevention or treatment of the atherosclerotic disease process itself and, as such, should be included as an integral part of any management plan for the many acute or chronic manifestations of this disease.

PREVALENCE OF RISK FACTORS % Dans A. et al National Nutrition and Health Survey (NNHeS): Atherosclerosis-related Diseases and Risk Factors and 2008

OBEJCTIVES General Objective: –Evaluate effectiveness of the primary prevention control program for CVD of the Preventive Cardiology Division of the Philippine Heart Center. Specific Objectives: –Determine the mean change of the SBP, DBP, FBS and lipid profile from baseline and on follow-up. –Determine the percentage of patients who eventually developed CVD.

METHODOLOGY Trial Design –Retrospective cohort trial. Inclusion Citeria –Adults > 21 years old –Any one of the major risk factors. –Any one of the predisposing risk factors but with at least 1 major risk factor. –Patients with a minimum follow-up period of 3 consecutive years and at least 2 follow-ups per year will be included in the efficacy analysis of the study. Exclusion Criteria –Patients are considered ineligible to participate if they have an existing atherosclerotic cardiovascular disease (e.g. CAD, CVA, etc.) MAJOR RISK FACTORS Hypertension Diabetes mellitus Dyslipidemia PREDISPOSING RISK FACTORS Obesity Physical inactivity Family history of premature CHD

INTERVENTION Health Education Nutrition Counseling Exercise Prescription Guideline for the management of individual risk factors provided by the following: –NCEP-ATP III –JNC VII –ADA’s Standards of Diabetes Care

Data Management Data for all enrolled patients were captured in an initial evaluation form and the follow-up data were written on the follow-up forms. The data were encoded in a computerized database designed specifically for the clinical trial by trained data encoder.

Data Analysis The distribution of the baseline characteristics were described. The BP, FBS, lipid profile for all visits were plotted in a graph. The mean change from baseline and on follow- up for the BP, FBS, and lipid profile were estimated at 95% confidence level. The percentage of patients who developed CVD during the follow-up period were determined.

RESULTS From February 2002 to December 2009, there were a total of 1008 patients who are actively following up at our clinic. Out of the 1008 patients being seen at our clinic, 148 patients, satisfied the inclusion criteria for assessment of efficacy of treatment intervention.

RESULTS N = 1008 patients Sex: Age:

RESULTS N = 148 patients

BP on follow-up BP reduction from baseline of 11/20 mmHg (p< 0.05)

FBS on follow-up FBS mean reduction of 51 mg/dL from baseline (p = 0.79).

Lipid Profile on follow-up TC mean reduction = 24mg/dl (p=0.49); TG mean reduction = 55mg/dl (p=0.002); HDL mean reduction = 1mg/dl (p=ns); LDL mean reduction = 11mg/dl (p=ns)

RESULTS During the seven years follow-up: –six patients (4 males and 2 females) died due to cardiovascular disease –three (2 males and 1 female) died from other causes One female patient had myocardial infarction. Two males had cerebrovascular accident.

Conclusions The results of our intervention on our patients enrolled in the Primary Prevention Clinic showed a reduction in the CV risk factors. Though the BP reduction was significant, the target blood pressure set by the guidelines was not achieved. There were reductions in the FBS, TC and LDL- C but was not statistically significant. There was a significant decrease in TG and a non-significant small decrease in HDL-C.

Recommendations Strengthening of the health education programs, including the nutrition counseling, should be done. Exercise programs that will address the concern on obesity should be strengthened. Intervention programs to help stop smoking should also be initiated.

An ounce of prevention is better than a pound of cure. Thank you!