Cardiovascular medications in primary care: treatment gaps and targeting by absolute risk

Aim To measure the use of three major types of cardiovascular medications (antiplatelet, blood pressure lowering, and cholesterol lowering) in primary care, and their level of targeting to individuals at high absolute risk of a cardiovascular event. Methods Demographic, risk factor, and prescribing data from the Dunedin Royal New Zealand College of General Practitioners Research Unit database were analysed. The data set consisted of 25,384 individuals, men aged at least 45 years and women at least 55 years, who consulted a doctor in 2000 in a practice which supplied electronic clinical notes. People with congestive heart failure were excluded. Five-year risk of a cardiovascular event was estimated using a history of vascular disease or the Framingham risk equation, and correlated with prescribed medications. Results Cardiovascular risk could be estimated for only one-third of the study population due to missing risk factor information. Data were largely unavailable on antiplatelet agents and so lipid lowering and blood pressure lowering medications were used to assess the “treatment gap”. This combination was prescribed to onl