Open Access Research article

Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study

Eliseo Guallar1234*, José R Banegas56, Elena Blasco-Colmenares1, F Javier Jiménez7, Jean Dallongeville8, Julian P Halcox9, Claudio Borghi10, Elvira L Massó-González11, Mónica Tafalla11, Joep Perk12, Guy De Backer13, Philippe G Steg14 and Fernando Rodríguez-Artalejo56

Author Affiliations

1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA

2 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA

3 Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, 21205, USA

4 Area of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research (CNIC), Madrid 28029, Spain

5 Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid 28029, Spain

6 CIBER of Epidemiology and Public Health, Madrid 28029, Spain

7 Medical Department, AstraZeneca Europe, Zaventem 1935, Belgium

8 Inserm U 744, Institut Pasteur de Lille, Lille Cedex 59019, France

9 Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff CF14 4XN, UK

10 Department of Internal Medicine, Aging and Clinical Nephrology, University of Bologna, Bologna 40100, Italy

11 Medical Department, AstraZeneca Farmacéutica Spain SA, Madrid 28003, Spain

12 School of Health and Caring Sciences, Linnaeus University, Kalmar 391 82, Sweden

13 Department of Public Health, University of Gent, Gent 9000, Belgium

14 INSERM U 698, Assistance Publique-Hôpitaux de Paris and Université Paris 7, Paris 75018, France

For all author emails, please log on.

BMC Public Health 2011, 11:704  doi:10.1186/1471-2458-11-704

Published: 18 September 2011



Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe.


Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account.


The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27).


Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

cardiovascular disease; mortality; risk factors; control; SCORE