Secondary prevention in coronary artery disease. Achieved goals and possibilities for improvements

• Published in: International journal of cardiology Vol. 161; no. 1; pp. 18 - 24
• Main Authors: Libungan, Berglind, Stensdotter, Lillemor, Hjalmarson, Agneta, Attebring, Mona From, Lindqvist, Jonny, Bäck, Maria, Herlitz, Johan
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.11.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Angina pectoris; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Case-Control Studies; Coronary artery disease; Coronary Artery Disease - epidemiology; Coronary Artery Disease - mortality; Coronary Artery Disease - prevention & control; Coronary heart disease; Data Collection - methods; Female; Goals; Health and Caring Sciences; Heart; Humans; Hälsovetenskap; Male; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Middle Aged; Myocardial infarction; Myocarditis. Cardiomyopathies; Patient Discharge - trends; Risk Factors; Risk Reduction Behavior; Secondary prevention; Secondary Prevention - methods; Secondary Prevention - trends; Smoking - adverse effects; Smoking - epidemiology; Smoking - therapy; Myocardial infarction; Secondary prevention; Angina pectoris; Coronary artery disease; Prevention; Improvement; Secondary; Cardiovascular disease; Cardiology; Myocardial disease; Coronary heart disease
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2011.04.025

Abstract Aim To describe presence of risk indicators of recurrence 6 months after hospitalisation due to coronary artery disease at a university clinic. Methods The presence of risk indicators, including tobacco use, lipid levels, blood pressure and glucometabolic status, including 24-hour blood pressure monitoring and an oral glucose-tolerance test, was analysed. Results Of 1465 patients who were screened, 402 took part in the survey (50% previous myocardial infarction and 50% angina pectoris). Mean age was 64 years (range 40–85 years) and 23% were women. Present medications were: lipid lowering drugs (statins; 94%), beta-blockers (85%), aspirin or warfarin (100%) and ACE-inhibitors or angiotensin II blockers (66%). Values above target levels recommended in guidelines were: a) low density lipoprotein (LDL) in 40%; b) mean blood pressure (day or night) in 38% and c) smoking in 13%. Of all patients, 66% had at least one risk factor (LDL or blood pressure above target levels or current smoking). An abnormal glucose-tolerance test was found in 59% of patients without known diabetes. If no history of diabetes, 85% had either LDL or blood pressure above target levels, current smoking or an abnormal glucose-tolerance test. However, with treatment intensification to patients with elevated risk factors 56% reached target levels for blood pressure and 79% reached target levels for LDL. Conclusion Six months after hospitalisation due to coronary artery disease, despite the high use of medication aimed at prophylaxis against recurrence, the majority were either above target levels for LDL or blood pressure or continued to smoke.