Risk Factor Control in a Portuguese Vascular Risk Clinic: A 16-Month Retrospective Cohort Study.

Background Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide and in Portugal. Stroke remains one of the principal causes of death in Portugal, increasing the urgency of efficient primary and secondary preventive strategies. Methods A retrospective cohort study was conducted, including 229 patients followed at a specialized vascular risk clinic between January 2022 and April 2023, corresponding to 820 outpatient visits. Electronic medical records were retrospectively reviewed, and an anonymized database was created to collect demographic data, referral origin, cardiovascular risk factors, therapeutic management, and risk factor control. Recorded variables included age, sex, number of consultations, blood pressure, body mass index, lipid profile, fasting glucose, and glycated hemoglobin. Patients were classified into primary or secondary prevention groups; cardiovascular risk in primary prevention was assessed using SCORE2 and SCORE2-OP models. Current patterns of antihypertensive use and glycemic control were descriptively compared with data from an internal institutional study conducted in 2011-2012. Results A total of 229 patients were included (57% male), with a mean age of 70.5 years. Most referrals originated from inpatient hospitalization or other outpatient specialty clinics. Secondary prevention accounted for 76% of patients, and 96% of the cohort was classified as high or very high cardiovascular risk. Dyslipidemia (94%), hypertension (93%), and diabetes mellitus (63%) were highly prevalent, with 69% of patients presenting three or more cardiovascular risk factors. Hypertension was present in 212 patients, most requiring combination therapy, and blood pressure control according to European Society of Cardiology targets was achieved in 76%. Compared with data from 2011 to 2012, prescribing patterns evolved with increased use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers, reduced use of angiotensin receptor blockers and diuretics, and the introduction of sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists. Diabetes mellitus was predominantly type 2 (94%), with a mean glycated hemoglobin of 6.6%, representing an improvement compared with a decade earlier. The use of newer antidiabetic agents, including SGLT2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, was substantial despite prescription constraints. Dyslipidemia management relied mainly on statin-based therapies, frequently in combination with ezetimibe. Overweight and obesity were common, and target organ damage, particularly cerebrovascular disease and chronic kidney disease, was frequently observed. Conclusions Patients followed in a specialized vascular risk clinic had a very high burden of modifiable cardiovascular risk factors, with most being classified as at high or very high cardiovascular risk. Nevertheless, a substantial proportion achieved recommended targets for blood pressure and glycemic control, reflecting the impact of structured, specialized follow-up. These findings underscore the importance of comprehensive and regularly reassessed preventive strategies in aging populations.