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Drug therapy and counselling to prevent heart attacks and strokes in eligible persons (Indicator 18)

Published


The indicator describes the following: Proportion of eligible people (defined as individuals with existing cardiovascular disease or who have a 10-year cardiovascular risk of 30 per cent or higher) receiving drug therapy and counselling to prevent heart attacks and strokes.


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This indicator is part of Target (8): At least 50 per cent of eligible people receive drug therapy and counselling to prevent heart attacks and strokes.

A combination of age, gender, smoking status, blood pressure and total cholesterol will identify a group of eligible individuals with a 10-year cardiovascular risk of 30 per cent or higher based on NORRISK 2 score. The group of eligible persons also includes all individuals who state that they already have or have suffered from cardiovascular disease.

We state the proportion of eligible persons reporting use of medication to lower blood sugar, cholesterol and blood pressure. 

Results

The proportion reporting use of blood glucose-lowering, cholesterol-lowering or antihypertensive medications among those aged 45-74 who have been diagnosed with angina or cardiovascular disease, or who are at high risk of cardiovascular disease, in Tromsø, increased from 66 per cent in 2006/07 to 83 per cent in 2015/16. This is shown by data from the Tromsø Study.

The group of eligible persons was mainly comprised of people who reported that they had a diagnosed cardiovascular disease (Figure 1). The reported used of medication to reduce the blood’s ability to clot, is not included in the calculation. This means that the proportion who receive drug therapy and counselling to prevent heart attacks and strokes may be higher than shown in Figure 2.

Figures from national analyses in the Cardiovascular Registry show that around 90 per cent of the patients who were admitted with heart attacks and strokes in 2012-2013 collected a prescription for anti-clotting medication. 

Cardiovasc medicine Tromsø NCD.jpg

Figure 1. Proportion reporting use of blood glucose-lowering, cholesterol-lowering and/or antihypertensive drugs among eligible persons in Tromsø, as a percentage. Eligible persons are defined as people aged 45-74 with self-reported angina, heart attack or stroke, or who have a 10- year cardiovascular risk of 30 per cent or higher, as estimated by the NORRISK 2 score. Source: Tromsø Study.  

Table accompanying Figure 1

 

2007-08

2015-16

Self-reported angina, heart attack or stroke

59.2

77.3

NORRISK 2 ≥ 30 per cent without self-reported angina, heart attack or stroke

6.5

5.9

Total eligible persons

65.7

83.2

Table 1 Proportion reporting use of antihyperglycemic, cholesterol-lowering and/or antihypertensive medication among eligible persons in Tromsø, as a percentage. Eligible persons are defined as people aged 45-74 with self-reported angina, heart attack or stroke, or who have a 10- year cardiovascular risk of 30 per cent or higher, as estimated by the NORRISK 2 score. Source: Tromsø Study. 

Data sources

The data source for this indicator is the Tromsø Study

A description and definitions follow below.

Data source: Tromsø Study

Description  

The Tromsø Study began in 1974 and consists of repeated health checks on Tromsø municipality’s population. The last two studies are particularly relevant to the period that WHO would like Member States to report on: 2010-2025. Tromsø 6 (2007-2008) included almost 13 000 adults between the ages of 30 and 87, and had an attendance rate of 63 per cent. Tromsø 7 (2015-2016) included more than 21 000 adults aged 40 and older, and had an attendance rate of 65 per cent.

Effect measure 

Proportion reporting current use of blood glucose-lowering, cholesterol-lowering and/or antihypertensive drugs among eligible persons. Eligible persons are here defined as individuals aged 45-74, who reported that they had cardiovascular disease (angina pectoris, heart attack or stroke) and/or people with a 10-year cardiovascular risk of 30 per cent or higher as estimated by the NORRISK 2 score. 

Blood glucose-lowering, cholesterol lowering and/or antihypertensive drugs include one or more of the following :

  • Blood glucose-lowering drugs including insulin
  • Antihypertensive medications
  • Cholesterol-lowering drugs 

A 10-year cardiovascular risk was calculated using the NORRISK 2 score. The risk score is a combination of age, gender, smoking status, blood pressure, antihypertensive medication, total cholesterol, HDL cholesterol and having close relatives who had heart attacks at an early age. The score states a person’s risk of having a heart attack or stroke in the course of the next 10 years. The risk score is based on Norwegian health surveys, hospital admittances and causes of death.

NORRISK 2 references

Research article on NORRISK 2: Selmer R et al. NORRISK 2: A Norwegian risk model for acute cerebral stroke and myocardial infarction. Eur J Prev Cardiol 2017;24(7):773-782

Interpretation and sources of error 

The reported use of medication to reduce the blood’s ability to clot, is not included in the calculation. This means that the proportion who receive drug therapy and counselling to prevent heart attacks and strokes may be higher than the data shown in Figure 2. 

The proportion of individuals attending health checks has gradually declined over time. No assessment has been made as to the possible implications of changes in the attendance rate for the comparability of data over time.  

Global indicator definition

WHO’s definition of the indicator

Indicator 18. Proportion of eligible persons (defined as aged 40 years and older with a 10-year cardiovascular risk ≥ 30 per cent, including those with existing cardiovascular disease) receiving drug therapy and counselling (including blood glucose control) to prevent heart attacks and strokes. 

National adaptation

We have calculated the risk of cardiovascular disease using the NORRISK 2 score. This is based on the Norwegian national context. We have not used WHO’s risk score (WHO/International society of hypertension risk prediction chart). NORRISK 2 and WHO’s risk score are based on many of the same risk factors. The scores differ from each other in some areas; NORRISK 2 is in addition based on heart disease in the family and also includes HDL cholesterol, on the other hand, diabetes is not included in the NORRISK 2 risk score. 

We have provided data on the proportion receiving drug therapy to prevent cardiovascular disease. We do not have data on the proportion receiving preventative counselling. 

WHO has defined preventative drug therapy as including medications that reduce blood sugar, cholesterol and blood pressure, as well as medications that reduce the blood’s ability to clot, e.g. Albyl-E. The Tromsø Study does not provide data on the reported use of medications that reduce the blood’s ability to clot. We have therefore supplemented data from the Cardiovascular Registry and the Norwegian Prescription Database on the use of preventative anti-clotting medications by patients who have been admitted with heart attacks or strokes. 

Authors and contacts

Text compiled by the Department of Non-Communicable Diseases, the Norwegian Institute of Public Health in collaboration with the Tromsø Study at the University of Tromsø.