Less than 0.5% of Brazilians with arterial disease follow medical guidelines

Heart disease remains the leading cause of death in Brazil, with over 237,000 fatalities in 2024. A study published last year reveals that even among Brazilians diagnosed with arterial diseases, only a tiny fraction follows the full recommendations for cardiovascular prevention. Coordinated by the Hcor Research Institute with participation from the D’Or Institute for Research and Education (IDOR), the NEAT initiative showed that just 0.3% of patients with atherothrombosis adhere to all recommended medical practices to reduce the risk of heart attacks and strokes. The results were published in the journal Scientific Reports.

The Silent Threat of Atherothrombosis

Atherothrombosis is a condition that affects the circulatory system and is characterized by the formation of fatty plaques and blood clots in the arteries. Over time, these blockages can impede proper blood flow, leading to serious events like acute myocardial infarction and stroke. Despite its severity, treatment is often limited to medications and lifestyle changes—which patients don’t always follow.

To better understand how these patients behave in a real-world setting, researchers at IDOR and partner institutions developed the Network to Control Atherothrombosis (NEAT). The study is a prospective, observational, national, and multicenter registry—the first of its kind focused on Brazilian patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD).

From September 2020 to March 2022, NEAT collected data from 2,003 patients across 25 healthcare centers located in all five regions of Brazil, including both public (56%) and private (44%) facilities. Information was collected in a standardized way over the course of one year, a common practice for data collection in real-world studies, where the results reflect what actually happens in clinics and hospitals, not just what is outlined in ideal protocols or controlled clinical trials.

Of the patients, 55.6% had only coronary disease, 28.7% had isolated peripheral artery disease, and 15.7% suffered from both. The majority were men (65.7%), with an average age of 66.3 years.

Prevention That Almost No One Follows

The main goal of the study was to see how many patients correctly followed evidence-based medical recommendations to reduce their cardiovascular risk. These practices cover seven key areas: the use of antithrombotic medications, control of blood pressure, cholesterol, and blood sugar, maintaining an ideal body weight, engaging in physical activity, and quitting smoking.

The results were alarming. Only 0.3% of participants followed all recommendations. Additionally, just 12.5% exercised for at least 150 minutes per week, and only 8.6% reached the ideal LDL cholesterol target (<55 mg/dL).

Why Aren't Therapies Followed?

Surprisingly, the main barrier to adopting these measures wasn't financial, but rather a lack of physician judgment. In more than half of the cases, healthcare professionals simply did not prescribe the treatments recommended by international guidelines because they did not consider the indication to be routine.

This "therapeutic inertia"—when a doctor fails to adopt new, evidence-based practices—was identified as one of the major obstacles to the advancement of cardiovascular prevention in Brazil.

Possible and Urgent Paths Forward

The NEAT study exposes a worrying reality where patients diagnosed with cardiovascular diseases are not receiving or following adequate treatment to prevent future events. Fragmented adherence to treatments compromises their effectiveness and increases the burden of preventable diseases (and deaths) in the country.

According to the study's authors, a more comprehensive and continuous approach that combines medical education, quality monitoring, and incentives for behavior change is urgently needed to alter this scenario. Large-scale population-based strategies, integrating both public and private centers, could be decisive in promoting prevention and reducing the impact of atherothrombosis in Brazil.

Written by Maria Eduarda Ledo de Abreu.