Adherence to guidelines to prevent cardiovascular diseases: The LifeLines cohort study

J. W. Balder, S. Scholtens, J. K. de Vries, L. M. van Schie, S. M. Boekholdt, G. K. Hovingh, P. W. Kamphuisen, J. A. Kuivenhoven*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Scopus)


Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. While there is indisputable evidence that statin treatment reduces the burden of CVD, undertreatment remains a concern for primary and secondary prevention. The aim of this study was to assess the use of lipid-lowering drugs (LLD) among 70,292 individuals in the Netherlands as a proxy of adherence to the national guideline for prevention and treatment of CVD.

Methods: LifeLines is a population-based prospective cohort study in the three Northern provinces of the Netherlands. At baseline, all participants completed questionnaires, and underwent a physical examination and lab testing. The national guidelines were used to assess how many participants were eligible for LLD prescription and we analysed how many indeed reported LLD use.

Results: For primary prevention, 77% (2515 of 3268) of those eligible for LLD treatment did not report using these drugs, while for secondary prevention this was 31% (403 of 1302). Patients with diabetes mellitus were treated best (67%) for primary prevention. Notably, of the patients with stroke, only 47% (182 of 386) reported LLD treatment.

Conclusion: Despite clear guidelines and multiple national initiatives to improve CVD risk management, adherence to guidelines for the treatment of CVD in the Netherlands remains a major challenge. This study calls out for improving public awareness of CVD and to improve primary and secondary prevention to prevent unnecessary CVD-related morbidity and mortality.

Original languageEnglish
Pages (from-to)316-323
Number of pages8
JournalThe Netherlands Journal of Medicine
Issue number7
Publication statusPublished - Aug-2015


  • Cardiovascular risk
  • primary prevention
  • secondary prevention
  • statins
  • undertreatment
  • underuse
  • risk assessment
  • RISK

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