Open Access Open Access  Restricted Access Subscription or Fee Access

Efforts to close the evidence-practice gap in the management of cardiovascular risk factors in general practice: strategic or haphazard?

Mariko Carey, Sze Yoong, Rob Sanson-Fisher, Chris Paul, Kerry Inder, Meredith Makeham


Rational, aims and objectives: Guidelines for best practice management of cardiovascular disease (CVD) risk factors such as smoking, high blood pressure, high cholesterol, risky alcohol consumption, diabetes and obesity are in place in the primary care setting, yet many of these risk factors remain uncontrolled. This review examined: a) trends in the number of published provider-focussed intervention studies which aimed to improve the identification and management of modifiable CVD risk factors in primary care; b) the proportion of primary care research effort directed toward improving provider management of each CVD risk factor compared to the  mortality burden associated with each risk factor in high income countries.

Methods: An electronic database search of Medline, Cinahl and PsychInfo was conducted for the time period January 1st 1999 to 31st December 2010 to identify relevant articles.

Results: There was a trend toward an increase in the number of provider-focussed interventions to improve the management of CVD risk factors in general practice over time. The proportion of research effort directed to risk factors varied between 6% for alcohol and obesity to 32% for high blood pressure. High blood pressure and smoking had the highest and second highest proportion of research effort and were ranked second and first, respectively, in terms of mortality burden.

Conclusions: The allocation of research effort appears somewhat consistent with the health burden associated with the risk factors examined in this review, although an increase in smoking-related research may be needed.

Full Text:



World Health Organization. Cardiovascular diseases (CVDs). 2011 (cited 2011 June 3rd); Available from:

Kahn, R., Robertson, R.M., Smith, R. & Eddy. D. (2008). The Impact of Prevention on Reducing the Burden of Cardiovascular Disease. Circulation 118 (5), 576-585.

Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F. et al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364 (9438), 937-952.

Australian Institute of Health and Welfare. Living dangerously: Australians with multiple risk factors for cardiovascular disease. Canberra: AIHW2005 Contract No.: 24.

Britt, H., Miller, G. C., Charles, J., Valenti, L., Fahridin, S., Pan, Y., Harrison, C., Bayram, C., O'Halloran, J. & Henderson, J. (2010). General practice activity in Australia 2009-10. General Practice Series. Canberra: Australian Institute of Health and Welfare.

Australian Bureau of Statistics. Health services: Patient Experiences in Australia, 2009. Canberra: ABS2009.

Britt, H., Miller, G.C., Knox, S., Charles, J., Valenti, L., Pan, Y. et al. (2004). General practice activity in Australia 2003–04. Canberra: Australian Institute of Health and Welfare.

Harris, M. (2008). The role of primary health care in preventing the onset of chronic disease, with a particular focus on the lifestyle risk factors of obesity, tobacco and alcohol. Canberra: National Preventative Health Taskforce.

Harris, M.F. & Mercer, P.J. (2001). Reactive or preventive: the role of general practice in achieving a healthier Australia. Medical Journal of Australia 175 (2). 92-93.

The Royal Australian College of General Practitioners. Curriculum statement: Population health and public health. Melbourne: RACGP 2007.

Wittchen, H-U., Glaesmer, H., März, W., Stalla, G., Lehnert, H., Zeiher, A.M., et al. (2005). Cardiovascular risk factors in primary care: methods and baseline prevalence rates - the DETECT program. Current Medical Research and Opinion 21 (4), 619-629.

British Cardiac Society, British Hypertension Society, Diabetes UK, Heart UK, Primary Care Cardiovascular Society, Stroke Association. (2005). JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91 (Supplement 5), 1-52.

De Backer, G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkova, R., Dallongeville, J. et al. (2003). European guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 24 (17), 1601-1610.

National Preventative Health Taskforce. (2009). Australia: The healthiest country by 2020 – National Preventative Health Strategy – Overview. Canberra: National Preventative Health Taskforce.

MacDonald, T.M. & Morant, S.V. (2008). Prevalence and treatment of isolated and concurrent hypertension and hypercholesterolaemia in the United Kingdom. British Journal Clinical Pharmacology 65 (5). 775-786.

Godwin, M., Pike, A., Kirby, A., Jewer, C. & Murphy, L. (2008). Prehypertension and hypertension in a primary care practice. Canadian Family Physician ;54 (10), 1418-1423.

Reid, C.M., Nelson, M. R., Shiel, L., Chew, D. P., Connor, G. & Delooze, F. (2008). Australians at Risk: Management of Cardiovascular Risk Factors in the REACH Registry. Heart, Lung and Circulation 17 (2), 114-118.

Reid, A.L., Webb, G.R., Hennrikus, D., Fahey, P.P. & Sanson-Fisher, R.W. (1986). Detection of patients with high alcohol intake by general practitioners. British Medical Journal (Clinical Research Ed) 293 (6549), 735-737.

O'Loughlin, J., Makni, H., Tremblay, M., Lacroix, C., Gervais, A., Dery, V., Meshefedjiang, G. & Paradis, G. (2001), Smoking cessation counseling practices of general practitioners in Montreal. Preventive Medicine 33 (6), 627-638.

Young, J.M. & Ward, J.E. (2001). Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers. Family Practice 18 (1), 14-20.

Huang, J.M.D., Yu, H.M.D.P., Marin, E.M.A., Brock, S.M.A., Carden, D.M.D. & Davis, T.P. (2004). Physicians' Weight Loss Counseling in Two Public Hospital Primary Care Clinics. Academic Medicine 79 (2), 156-161.

Cochrane Effective Practice and Organisation of Care Review Group. (2002). Data collection checklist.Available from:

Kanjilal, S., Gregg, E.W., Cheng, Y.J., Zhang, P., Nelson, D.E., Mensah, G. & Beckles, G.L. (2006). Socioeconomic Status and Trends in Disparities in 4 Major Risk Factors for Cardiovascular Disease Among US Adults, 1971-2002. Archives of Internal Medicine 166 (21), 2348-2355.

Lee, D.S., Chiu, M., Manuel, D.G., Tu, K., Wang, X., Austin, P.C. et al. (2009). Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors. Canadian Medical Association Journal 181 (3-4), E55-66.

Tu, K., Chen, Z. & Lipscombe, L.L. (2008). Canadian Hypertension Education Program Outcomes Research T. Mortality among patients with hypertension from 1995 to 2005: a population-based study. Canadian Medical Association Journal 178 (11), 1436-1440.

Centers for Disease Control and Prevention. (2009). State-specific prevalence and trends in adult cigarette smoking-United States, 1998-2007. MMWR Morbidity and Mortality Weekly Report 58 (9), 221-226.

White, V., Hill, D., Siahpush, M. & Bobevski, I. (2003). How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tobacco Control 12 (Supplement 2), ii67-74.

Park, E.J., Koh, H.K., Kwon, J.W., Suh, M.K., Kim, H. & Cho, S.I. (2009). Secular trends in adult male smoking from 1992 to 2006 in South Korea: age-specific changes with evolving tobacco-control policies. Public Health 123 (10), 657-664.

Cifkova, R., Skodova, Z., Bruthans, J., Adamkova, V., Jozifova, M., Galovcova, M. et al. (2010). Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/8. Czech MONICA and Czech post-MONICA. Atherosclerosis 211 (2), 676-681.

Jemal, A., Thun, M.J., Ries, L.A.G., Howe, H.L., Weir, H.K., Center, M.M. et al. (2008). Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control. Journal of the National Cancer Institute 100 (23), 1672-1694.

Wakefield, M.A., Loken, B. & Hornik, R.C. (2010). Use of mass media campaigns to change health behaviour. Lancet 376 (9748), 1261-1271.

Lopez de Andres, A., Ezzati, M., Jamison, D.T. & Murray, C.J.L. (Eds.) (2006). Global Burden of Disease and Risk Factors. Washington DC: The World Bank and Oxford University Press. Geneva: WHO Press.

Beard, H.A., Al Ghatrif, M., Samper-Ternent, R., Gerst. K., Markides, K.S., Beard, H.A. et al. (2009). Trends in diabetes prevalence and diabetes-related complications in older Mexican Americans from 1993-1994 to 2004-2005. Diabetes Care 32 (12), 2212-2217.

Magliano, D.J., Peeters, A., Vos, T., Sicree, R., Shaw, J., Sindall, C., Haby, M., Begg, S.J. & Zimmet, P.Z. (2009). Projecting the burden of diabetes in Australia-what is the size of the matter? Australian and New Zealand Journal of Public Health 33 (6), 540-543.

Shaw, J.E., Sicree, R.A. & Zimmet, P.Z. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice 87 (1), 4-14.

Wild, S., Roglic, G., Green, A., Sicree, R. & King, H. (2004). Global Prevalence of Diabetes. Diabetes Care 27 (5), 1047-1053.

Murray, C.J.L., Lauer, J.A., Hutubessy, R.C.W., Niessen, L., Tomijima, N., Rodgers, A., Lawes, C.M. & Evans, D.B. (2003). Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet 361 (9359), 717-725.

Anderson, P., Chisholm, D. & Fuhr, D.C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet ;373 (9682), 2234-2246.

Giesbrecht, N.& Greenfield, T.K. (2003). Preventing Alcohol-Related Problems in the US Through Policy: Media Campaigns, Regulatory Approaches and Environmental Interventions. Journal of Primary Prevention 24 (1), 63-104.

Shaw, K., Gennat, H., O'Rourke, P. & Del Mar, C. (2006). Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006(4):CD003817.

Melkus, G.D. (2005). Review: non-pharmacological interventions induce or maintain weight loss in adults with prediabetes. Evidence Based Nursing 8 (4), 110.

Padwal, R., Li, S.K., Lau, D.C. (2004). Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev. 2004(3):CD004094.

Tsai, A.G. & Wadden, T.A. (2009). Treatment of obesity in primary care practice in the United States: a systematic review. Journal of General Internal Medicine 24 (9), 1073-1079.

Mathers, N. & Gray, D.P. (2005). Cutting the cake: allocation of NHS research and development funding. British Journal of General Practice 55 (520), 827-828.

Foy, R., Parry, J. & McAvoy, B. (1998). Clinical trials in primary care: targeted payments for trials might help improve recruitment and quality. British Medical Journal 317 (7167), 1168-1169.



  • There are currently no refbacks.