Patients Presenting with Acute Coronary Syndrome Exhibit Insufficient Previous Management of Cardiovascular Risk Factors: A Prospective, Observational, Single-Center Study

Abstract

Objectives: Optimal regulation of modifiable risk factors, has been proposed as the standard of care, both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to investigate at what extent individuals who experienced an acute coronary syndrome (ACS) had previously been receiving adequate preventive measures against classical risk factors for CVD. Methods: Data were analysed for all 185 hospitalized patients with a diagnosis of ACS in the Cardiology department of our hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided into two groups, primary and secondary prevention subgroups, according to the previous medical history of CAD. Results: The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia. Hypertension was present in 101 (54.6%) patients and coronary artery disease (CAD) in 51 (27.9%). In the secondary prevention group, the LDL-C was on target in only one-third, while one out of 5 patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only one out of five patients had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in half of them. One-quarter of the patients were active smokers. In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk (47.1% and 32.1%, respectively). Overall, the LDL-C was on target in less than one-quarter of patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target at 61.8%. Active smoking was practiced by more than one-third of the patients. Conclusion: Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies.