PhD ceremony Ms. A.H. Tiessen: Cardiovascular risk management in general practice

PhD ceremony: Ms. A.H. Tiessen

Dissertation: Cardiovascular risk management in general practice

Promotor(s) prof. K. van der Meer, prof. A.J. Smit

Faculty: Medical Sciences

Cardiovascular diseases (CVDs) are amongst the leading causes of death and risk factors are highly prevalent. This thesis describes the research of a method for screening and treatment of cardiovascular risk factors in Dutch general practice.

First we analysed the outcomes of a screening method that was applied in the Dutch village Oude Pekela. This area has a low socioeconomic status, and its inhabitants have a relatively high prevalence of cardiovascular risk factors and low participation to prevention programmes. The screening programme resulted in a high attendance and identification of a considerable number of new high-risk persons. The outcome was much higher than the currently advocated “PreventieConsult” programme. Our findings may help to improve prevention programmes.

Next, the effects of an “AGE-reader” were evaluated. This method uses UV-light to measure specific proteins in the skin to identify high risk individuals. After three years individuals with a history of CVD were found to have a higher AGE. The clinical value of these findings are subject to further investigation.

Finally, risk factor treatment by practice nurses in general practice was studied. This treatment resulted in a significant decrease of estimated cardiovascular risk after one year. The study group that used additional self-monitoring (by means of home blood pressure measurements, pedometers and weighing scales) did not achieve an additional effect. The cost of CVD risk management in general practice is low. The costs due to productivity losses during practice visits are the main cost driver. Costs related to medication adjustment are low and these adjustments were related to a reduction in CVD-risk.

Due to the high prevalence of CVD-risk factors and rising health care costs, these results can contribute in choosing effective interventions.