Atherosclerotic Coronary Disease Research Articles

An increased waist-to-hip ratio is a key determinant of atherosclerotic burden in overweight subjects

Aim: The association of overweight status and cardiovascular disease is not clear. In this study we aimed to investigate coronary atherosclerotic disease, evaluated as coronary artery calcium score (CACs), in overweight patients with or without abdominal obesity as defined by waist-to-hip ratio (WHR).

Prognostic benefit of acute heart failure associated with atherosclerosis: the importance of prehospital medication in patients with severely decompensated acute heart failure.

Atherosclerotic diseases sometimes contribute to acute heart failure (AHF). The aim of the present study is to elucidate the prognostic impact of AHF with atherosclerosis. A total of 1226 AHF patients admitted to the intensive care unit were analyzed. AHF associated with atherosclerosis was defined by the etiology: atherosclerosis-AHF group (n = 708) (patients whose etiologies were ischemic heart disease or hypertensive heart disease) or AHF not associated with atherosclerosis (non-atherosclerosis-AHF) group (n = 518). Kaplan-Meier curves showed that the survival rate of the atherosclerosis-AHF group was significantly better than that of the non-atherosclerosis-AHF group within 730days of follow-up. Regarding pre-hospital medications, atherosclerosis-AHF patients were more likely to be administered nitroglycerin (20.3 vs. 13.7%, p = 0.003), nicorandil (18.8 vs. 7.5%, p < 0.001), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (46.5 vs. 38.6%, p = 0.006), β-blocker (33.2 vs. 26.6%, p = 0.014) and statin (30.1 vs. 22.4%, p = 0.003) because of a previous coronary event or atherosclerotic diseases. In sub-group analysis of medication including administered ≥ 3 drugs within 5 medications and ACE-I/ARB, atherosclerosis-AHF significantly decreased the rate of all-cause death within 180days (hazard ratio (HR) 0.215, 95% CI 0.078-0.593 and HR 0.395, 95% CI 0.244-0.641, respectively) with a significant interaction (p value for interaction 0.022 and 0.005, respectively). Kaplan-Meier curves showed that the 180-days survival rate of the atherosclerosis-AHF group with ACE-I/ARB and ≥ 3 drugs were significantly better than other groups. The AHF patients associated with atherosclerosis lead to be a good long-term outcome. A relationship may exist between efficient treatment including ACE-Is before admission and a good outcome in mid-term.

Relationship between TREM-1 gene polymorphism and susceptibility to coronary atherosclerotic heart disease

Objective To explore the relationship between gene polymorphisms of triggering receptor expressed on myeloid cells-1 (TREM-1) rs2234237A/T, rs9471535A/G and susceptibility to coronary atherosclerotic heart disease(coronary heart disease for short, CHD). Methods A case-control study. 120 patients with CHD (CHD group) and 90 healthy people (Normal control group) were selected from November 2016 to April 2017 in Jingzhou Central Hospital. The single nucleotide polymorphisms(SNPs) of TREM-1gene (rs2234237 and rs9471535)were analyzed using Sanger method in all subjects. Comparing baseline clinical data and the distribution of genotype frequencies in the two groups. Non conditional logistic regression was used to analyze the relationship between TREM-1 gene ( rs2234237 and rs9471535) polymorphisms and susceptibility to CHD. Results The proportion of gender as well as level of age, body mass index, total cholesterol, triglyceride and low density lipoprotein cholesterol were not statistically significant between the two groups(χ2 =0.575, P>0.05; t=-1.670, P>0.05; t=-1.719, P>0.05; t=1.011, P>0.05; t=-1.834, P>0.05; t=0.474, P>0.05, respectively), while the proportion of smoking, hypertension and diabetes as well as level of high density lipoprotein cholesterol and fasting plasma glucose were statistically significant between the two groups (χ2 =4.321, P 0.05). Conclusions TREM-1 gene rs2234237 A/T and rs9471535 A/G polymorphisms are significantly associated with susceptibility to CHD . rs2234237 TT genotype and rs9471535 GG genotype might act as protective factors of CHD.(Chin J Lab Med, 2018, 41: 436-441) Key words: Coronary disease; Triggering receptor expressed on myeloid cells-1; Polymorphism, single nucleotide; Disease susceptibility

Prognostic value of age adjusted segment involvement score as measured by coronary computed tomography: a potential marker of vascular age.

Extent of coronary atherosclerotic disease (CAD) burden on coronary computed tomography angiography (CCTA) as measured by segment involvement score (SIS) has a prognostic value. We sought to investigate the incremental prognostic value of 'age adjusted SIS' (aSIS), which may be a marker of premature atherosclerosis and vascular age. Consecutive patients were prospectively enrolled into the CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicentre) multinational observational study. Patients were followed for the outcome of all-cause death. aSIS was calculated on CCTA for each patient, and its incremental prognostic value was evaluated. A total of 22,211 patients [mean age 58.5 ± 12.7years, 55.8% male) with a median follow-up of 27.3months (IQR 17.8, 35.4)] were identified. After adjustment for clinical factors and presence of obstructive CAD, higher aSIS was associated with increased death on multivariable analysis, with hazard ratio (HR) 2.40 (1.83-3.16, p < 0.001), C-statistic 0.723 (0.700-0.756), net reclassification improvement (NRI) 0.36 (0.26-0.47, p < 0.001), and relative integrated discrimination improvement (IDI) 0.33 (p = 0.009). aSIS had HR 3.48 (2.33-5.18, p < 0.001) for mortality in those without obstructive CAD, compared to HR 1.79 (1.25-2.58, p = 0.02) in those with obstructive CAD. In conclusion, aSIS has an incremental prognostic value to traditional risk factors and obstructive CAD, and may enhance CCTA risk stratification.

Immunohistochemical study on dystrophin expression in CAD-related sudden cardiac death: a marker of early myocardial ischaemia.

The aims of this study were to assess if dystrophin can be a tool for the forensic evaluation of sudden cardiac death due to coronary atherosclerotic disease (CAD) and particularly if it can be a marker of early myocardial ischaemia. Then in this investigation, the dystrophin was compared to C5b-9 and fibronectin to analyze if there are some differences in the expression of these proteins. Two groups of CAD-related sudden cardiac death, respectively the group 1 with gross and/or histological evidence and the group 2 with no specific histological signs of myocardial ischaemia were used. A third group formed by cases of acute mechanical asphyxiation was used as a control. The immunohistochemical staining by dystrophin, C5b-9 and fibronectin antibodies was performed. Loss of sarcolemmal dystrophin was observed in different degrees according to more or less significant histological evidence of myocardial ischaemia. Moreover, the comparison between loss of dystrophin expression and fibronectin positivity showed significant differences in group 2. The results suggested that dystrophin can be used in forensic diagnosis of CAD-related sudden cardiac death and as marker of early myocardial ischaemia.

Impact of socioeconomic status on adverse cardiac events after coronary angioplasty: a cohort study

BackgroundSocioeconomic status (SES) has been associated with adverse cardiovascular events in coronary atherosclerotic disease. However, it is unclear how SES impacts adverse cardiac events in patients treated with percutaneous coronary...

An increased waist-to-hip ratio is a key determinant of atherosclerotic burden in overweight subjects.

The association of overweight status and cardiovascular disease is not clear. In this study we aimed to investigate coronary atherosclerotic disease, evaluated as coronary artery calcium score (CACs), in overweight patients with or without abdominal obesity as defined by waist-to-hip ratio (WHR). We enrolled 276 patients aged between 40 and 70 years, with a body mass index of 25-29.9 kg/m2 and at least one cardiovascular risk factor. Exclusion criteria were history of diabetes, cardiovascular or renal disease. Patients were stratified in high WHR (H-WHR) or low WHR (L-WHR) group according to WHR (≥0.85 for women and ≥0.90 for men) and underwent multi-detector computed tomography for CACs. Mean carotid intima-media thickness (IMT) and plaque presence were equally assessed. CACs was higher in the H-WHR group compared to L-WHR (9.05 [0.0-83.48] vs 0.0 [0.0-64.7] AU, p < 0.01); the prevalence of CACs > 0 in the H-WHR group was significantly higher than subjects with L-WHR (59.6% vs 38.5%, p < 0.001). Moreover, H-WHR group had higher mean IMT (0.64 [0.56-0.72] vs 0.59 [0.55-0.67] mm, p < 0.05) and higher carotid plaque prevalence (63.7% vs 50.8%, p < 0.05) compared to subjects with L-WHR. Logistic regression showed that H-WHR was associated with presence of CACs and carotid plaque (p < 0.01). In a multiple linear regression, WHR was positively associated with CACs and IMT (p < 0.01). H-WHR is a marker of coronary and peripheral atherosclerotic burden in overweight patients.

Correlation between plasma leptin hormone in diabetic patients and the extent of coronary artery disease

Objective The aim of this study was to assess the correlation between the level of plasma leptin hormone in diabetic patients with atherosclerotic coronary artery disease (CAD) and the extent of coronary artery lesion using coronary angiography. Background Leptin is a hormone secreted from adipose tissue and is increased in obese patients in whom there is an increased risk for atherosclerotic coronary disease which can be assessed by means of coronary angiography. Patient and methods A total of 50 diabetic patients with CAD were studied for the assessment of plasma leptin hormone level and its correlation with the extent of CAD by means of angiography. Results There was a positive correlation between the level of leptin hormone and the extent of CAD. Conclusion The study suggests that leptin is a significant cardiovascular risk factor for atherosclerotic CAD independent of traditional cardiovascular risk factors. Leptinemia is associated with several biochemical disorders, suggesting that leptin may be a pathogenic factor in cardiovascular disease.

Técnicas de imagen híbridas en cardiopatía isquémica

Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

30-Year-Old Man With Outside-of-Hospital Cardiac Arrest

MACHINE LEARNING IN PREDICTING CORONARY HEART DISEASE AND CARDIOVASCULAR DISEASE EVENTS: RESULTS FROM THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA)

We aimed to evaluate whether machine learning (ML) approach will allow improved prediction as compared to standard coronary artery calcium (CAC) and clinical risk assessments in prediction of coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD) events using the Multi-

Promoting effects of dual heart care mode on patients' health behaviors in perioperative period of coronary artery bypass surgery

Objective To evaluate the effects of dual heart care mode in perioperative period of coronary artery bypass grafting (CABG) surgery on improving health behavior in patients with coronary atherosclerotic heart disease. Methods A total of 131 patients with atherosclerotic heart disease who were treated in the Cardiac Surgery Department of Yancheng Third People's Hospital of Jiangsu Province from January 2011 to December 2016 were recruited by convenience sampling method. All the patients were divided into observation group (2014.1-2016.12, n=68) and control group (2011.1-2013.12, n=63) according to the admission date. The observation group was treated with dual heart path nursing mode, while the control group was treated with routine perioperative care. The scores of self-rating anxiety scale (SAS) , health promoting lifestyle profile (HPLP) and the incidence of adverse cardiovascular events were compared between the two groups. Results There was no significant difference in the incidence of anxiety, the scores of SAS and HPLP between the two group on admission (P>0.05) . Before surgery and 7 days after surgery, the incidence of anxiety and the score of SAS of the observation group were all lower than those of the control group, and the difference was statistically significant (P<0.05) . The score of HPLP of the observation group was higher than that of the control group before discharge, and the difference was statistically significant (P<0.05) . After surgery, there were 6 cases of adverse cardiovascular events in the observation group, and 17 cases in the control group. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group, with statistical significant difference (P<0.05) . Conclusions Dual heart path nursing mode guides nurses to give standardized perioperative holistic nursing and psychological nursing according to predetermined care plan, so that the perioperative nursing work is more standardized, more secure and more humanized. In conclusion, it improves the quality of nursing overall. Key words: Coronary artery bypass, off-pump; Perioperative nursing; Health behavior; Dual heart path care

Abstract TP206: Association of a Polymorphism From the Protein Convertase Subtilisin Kexin Type 9 in Atherosclerotic Ischemic Stroke in Two Latin American Populations

Background: the association of gain-of-function polymorphisms in PCSK9 gene has been proposed as a risk factor for coronary atherosclerotic disease, and recently with atherosclerotic ischemic stroke. Aims: we investigated the effect of E607G single nucleotide polymorphism (SNP) on the risk association of ischemic atherosclerotic stroke in two Latin-American (Costa Rica and a Mexico) cohorts. Materials and methods: Cases were selected according to A1 ASCOD phenotype criteria for atherosclerotic stroke from databanks in both countries, matched with stroke-free controls. Genotyping of the SNP was performed using real time polymerase chain reaction-based restriction fragment length polymorphism, and then confirmed by direct sequencing. Univariate analysis for high-risk genotype and Hardy-Weinberg equilibrium was assessed. Ancestry was confirmed for both populations. Results: One hundred ninety six (100 Costa Rican and 96 Mexican) ischemic atherotrombotic stroke cases, and 198 (100 Costa Rican and 98 Mexican) age-, gender- and risk factors-matched controls were included. Lipid profiles among cases and controls were consistent, with no significant differences among basal values. Main risk factors were higher in cases than in controls: hypertension (74.1% vs. 57.4%), known hypercholesterolemia (59.9% vs. 35.7%), diabetes (42.1% vs. 27%), and current smoking (34.5% vs. 21.4%). Partial anterior circulation infarction (59.4%), mainly from extracraneal atherosclerotic source (61.2%), with a median NIHSS score of 7, were the most important characteristics of cases included. High-risk genotype profile from E670G (GG), was present only in one control and one case from the entire population, with no association found for the homozygous model. Conclusion: the E607G polymorphism of the PCSK9 gene is not associated with an increased risk and severity of ischemic stroke in a Costa Rican and Mexican cohort. Keywords: PCSK9 gene, E607G, R218S, F216L, atherosclerotic stroke, polymorphism,

Hybrid Imaging in Ischemic Heart Disease

Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.

Epicardial fat thickness and severity of coronary heart disease in patients with diabetes mellitus type II.

BACKGROUNDClinical imaging studies have demonstrated a strong direct correlation between epicardial fat and abdominal visceral adiposity. There are several studies about positive correlation of epicardial fat and atherosclerotic coronary disease in general population. This study aimed to evaluate the association of epicardial fat thickness with atherosclerotic coronary disease in patients with diabetes mellitus type II.METHODSThis cross-sectional observational study involved 80 patients with diabetes mellitus type II. The patients were chosen using simple sampling method from patients with diabetes mellitus who were referred for angiography because of suspected coronary artery disease. The severity of coronary atherosclerotic lesions was evaluated using modified Gensini scoring system. Epicardial fat thickness was measured by transthoracic echocardiography within 90 days after coronary angiography. Multiple linear regression method was used to evaluate the association between mean epicardial fat thickness and Gensini score.RESULTSAfter adjustment for the effects of body mass index (BMI), age, angina, and sex, there was a significant association between Gensini score and epicardial fat thickness (β = 0.825; P < 0.001). Patients with higher blood pressure and higher body mass index also had a higher Gensini score (P < 0.010).CONCLUSIONIn patients with diabetes mellitus type II, there is a positive association between epicardial fat thickness and severity of coronary artery disease. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of the severity of coronary arteries diseases before using more invasive techniques.

Thrombus in the Right Coronary Sinus of Valsalva Originating From the Left Atrial Appendage Causing Embolic Inferior Wall Myocardial Infarction.

Acute myocardial infarction (MI) is commonly a result of coronary atherosclerotic plaque rupture and superimposed thrombus formation. Nevertheless, uncommon causes of MI including embolism from aortic root and ascending aorta mural thrombi must be considered when coronary atherosclerotic disease is not evident. We report a case of a 84-year-old woman who presented with an inferior ST-segment elevation MI. Initial attempts to engage the right coronary artery (RCA) were unsuccessful. Aortic angiography revealed evidence of the left coronary artery ostium with absence of the right coronary ostium or RCA. Probing with a coronary wire where the RCA ostium was presumed to be located yielded resolution of the ST-segment elevation. The RCA was then easily engaged using a guide catheter, and angiographic evaluation showed a smooth vessel with no evidence of coronary artery disease except for abrupt termination of the distal PL2 branch. Contrast-enhanced computed tomography revealed an aortic root thrombus extending into the right coronary sinus of Valsalva and a thrombus in the left atrial appendage. The case reveals RCA embolism from an aortic root thrombus likely originating from the left trial appendage. A conservative approach to treatment with anticoagulation was pursued that resulted in full recovery. A review of the literature revealed that the etiology of aortic root thrombi is proposed to be multifactorial. Prospective randomized studies are needed to demonstrate the best treatment approach, although this appears to be impracticable given the rarity of the disease.

The significant coronary tortuosity and atherosclerotic coronary artery disease; What is the relation?

Introduction: Although coronary tortuosity is relatively common in coronary angiograms, there is much debate over the significance of this anatomical variation. So in this study the relation between significant coronary tortuosity (SCT) and coronary artery disease (CAD) was examined. Methods: The cross-sectional study included 737 patients (57% male) who were admitted to the hospital for a coronary angiography, based on their symptoms or non-invasive imaging. Coronary arteries defined as SCT are in the presence of either ≥3 consecutive curvatures of 90◦ to 180◦ or ≥2 consecutive curvatures of ≥180◦ measured at the end-diastole, in a major epicardial coronary artery ≥2 mm in diameter. Results: 29.17% of the patients had SCT of which females (64.7% vs. 34.1%, P < 0.001) and higher aged persons (62.9±8.4 vs. 57.8±10.7 years ± SD; P < 0.001) were significantly associated with SCT compared to non-SCT. Left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) with SCT in comparison to non-SCT, had lesser probability of CAD with stenosis severity of ≥50% (34.5% vs. 46.1%; P = 0.019 and 17.7% vs. 31.1%; P = 0.001 and 27.9% vs. 43.5%; P = 0.013 respectively) and also had significant lower Gensini scores (4.1±5.3 vs. 8.4±11.9; P = 0.011; 2.1±3.4 vs. 5.2±9.5; P = 0.01 and 1.2±1.9 vs. 5.03±8.9; P < 0.001 respectively) but higher TIMI frame count (15.7±5.3 vs. 11.9±4.6; P < 0.001 and 17.1±4.4 vs. 12.7±4.4; P < 0.001 and 15.2±3.9 vs. 11.6±4.8; P < 0.001 respectively). Conclusion: SCT is negatively correlated with CAD and there is a significant association between SCT and reduced coronary flow rate.

Carotid intima-media thickness, flow-mediated dilatation and proteinuria in patients of human immunodeficiency virus-positive patients: A case-control study.

Introduction:Endothelium-dysfunction (ED) is a surrogate marker of coronary atherosclerotic disease. Carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and proteinuria are surrogate markers of ED. Few studies have shown that patients with HIV have impaired endothelial function and are thus at risk of accelerated atherosclerosis.Materials and Methods:The present study assessed ED in HIV patients by various biophysical parameters as brachial artery FMD, CIMT, and proteinuria. A total of 43 HIV-infected patients were compared with 25 healthy controls who were healthy.Results:Mean age of patients with HIV was 33.84 ± 5.61 years while that of healthy controls was 31.48 ± 5.40 years. Male to female ratio among cases was 24:19 while among controls was 17:8. Mean CIMT was significantly higher among cases than control (0.513 ± 0.079, 0.452 ± 0.050 mm, respectively, P = 0.001). Percentage change in FMD was significantly lower among cases than control (3.27 ± 2.01, 6.96 ± 1.28, respectively, P = 0.001). Urine protein grading was significantly different between cases and controls (P = 0.007), with stable HIV cases having significantly higher urine protein grading compared to healthy controls. However, no correlation was seen between CIMT, FMD, and proteinuria overall among cases and controls.Conclusions:HIV-infected patients have significant impairment of endothelial function, in the form of increased CIMT, impaired FMD, and more proteinuria as compared to healthy controls.

Coronary artery revascularization in infants, children, and adolescents: The internal mammary artery is still the conduit of choice.

In infants, children, and adolescents, the most common indication for coronary artery bypass graft surgery (CABG) has been Kawasaki disease or acquired familial hypercholesterolemia. However, pediatric CABG is now more commonly performed for coronary artery injuries which occur during or following arterial switch operations (ASO), the ross procedure, and tetralogy of Fallot repairs (TOF).1-3 CABG has also been performed in adults who present with acquired coronary atherosclerotic disease and have congenital lesions such as TOF.4 In adult CABG surgery, the internal mammary artery (IMA) is the conduit of choice because of its superior long-term patency. However, in infants, children, and adolescents, concerns have been raised regarding the use of the IMA because of competitive flow, the smaller diameter of the IMA, the size of the target vessel, the need for the IMA to provide the entire blood supply for large areas of the myocardium, and the potential of the IMA for somatic growth. In this edition of the Journal, Arnaz et al5 report their experience with CABG surgery in 10 children ranging from 88 days to 15 years. The indications for CABG included complications related to the ASO and the Ross procedure and iatrogenic injuries due to the anomalous location of coronary arteries during TOF repairs. Three patients died during the postoperative period, but none of the deaths were due to coronary ischemia. Eight patients received an IMA graft and two patients received saphenous vein grafts. Four of the eight IMA grafts underwent follow-up angiograms which showed patent IMA grafts in all patients. In two of these patients, the IMA grafts showed somatic growth after 9.5 and 18 years. None of the surviving seven patients had any recurrent angina, new Q waves, or a reduction in ejection fraction. Although the number of patients in this series is small, it confirms the results of other studies which have demonstrated that the IMA has excellent long-term patency and adapts well to somatic growth.6-8 Concerns regarding excessive stretching of the IMA as the children grow older have not materialized. Furthermore, the IMA's blood flow has been more than adequate to meet the demands of the myocardium in these younger patients. Arnaz et al5 have reaffirmed that the IMA can be successfully utilized in infants, children, and adolescents during complex procedures, even when emergent revascularization is necessary, and should be the conduit of choice in these young patients.

The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention.

The Joint European Societies (JES) guidelines on cardiovascular disease (CVD) prevention published in 1994, 1998, 2003, 2007, 2012 and 2016 defined lifestyle and risk factors targets for patients with coronary or other atherosclerotic disease and people at high risk of developing CVD. Guideline implementation in Europe has been evaluated with four cross-sectional EUROASPIRE surveys starting in mid-1990s. The results showed poor lifestyle and risk factor management in patients with CHD and in high CVD risk people with high prevalences of smoking, obesity, central obesity and diabetes. The control of blood pressure, lipids and glucose was far from optimal. A comparison across the recent three surveys provided a unique description of time trends for secondary prevention over a period of 14 years. The results showed adverse lifestyle trends, a substantial increase in obesity, central obesity and diabetes. Despite significant improvement of blood pressure and lipid control many patients were not reaching the risk factor goals and there was no change in glucose control. Comparing the most recent two surveys, there were no major differences in lifestyle and risk factor management in people at high risk of developing CVD. A new approach to CVD prevention integrating primary and secondary prevention into a modern preventive cardiology programme, focusing on lifestyle and risk factor management is required, in order to reduce the risk of CVD events and improve quality of life in patients with CHD and those at high risk of developing CVD.