Secondary Prevention Of Coronary Disease Research Articles

New Hope for Secondary Prevention of Coronary Disease

New Hope for Secondary Prevention of Coronary Disease

Implementation of recommendations on the check of risk factors for cardiovascular diseases in patients undergoing coronary re-interventions

MethodThe study involved 905 patients after coronary interventions, qualified for invasive diagnosis due to symptomatic coronary disease.AimThe aim of this study was to check the implementation of recommendations on the control of risk factors for cardiovascular diseases in patients undergoing re-interventions.ResultsCompared to elderly persons, younger people more often increased their physical activity (62 vs. 65 years, p = 0.009), stopped smoking (61 vs. 65 years, p < 0.001) and reduced alcohol consumption (62 vs. 65 years, p = 0.001). People with secondary and higher education increased their physical activity more often than those with primary education (51%, 31% vs. 23%, p = 0.006). Men more often than women decided to limit their alcohol consumption (48% vs. 37%, p = 0.007). Patients with a history of acute coronary syndrome were more likely to quit smoking and reduce their alcohol consumption than those without such a history (47% vs. 37%, p = 0.003 and 42% vs. 34%, p = 0.020, respectively). Only 2% of the subjects achieved the recommended LDL cholesterol values. Forty-eight percent were qualified for reinvasive procedures on the coronary arteries. Less than half of the patients undertook health-promoting behaviors that required modification of existing habits.ConclusionAge, gender, and education level influence pro-health behaviors. The majority of patients do not achieve the levels of LDL cholesterol and triglycerides consistent with the ESC guidelines in the secondary prevention of coronary disease. Inadequate check of risk factors may result in faster disease progression and coronary re-interventions.

Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future.

Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950’s; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary disease in light of societal changes as well as medical, digital and surgical advancements. Contemporary “cardiac rehabilitation” began when bed rest and physical inactivity was recommended and commonplace for MI survivors. Today, most patients who survive an MI, undergo reperfusion therapy, a short inpatient stay and are discharged with minimal physical morbidity. Despite this, the majority of modern day programs continue to be structured in the same way they have been for the past 50 years and this model has become incongruent with the contemporary context, especially in the COVID-19 era. This review aims to describe the historical foundations of cardiac rehabilitation to inform solutions and meet the demands of contemporary MI management. Delivering health systems reform to address modernization is current healthcare challenge where a united and interdisciplinary effort is needed.

Colchicine for secondary prevention in coronary disease.

Colchicine for secondary prevention in coronary disease.

Statins as a Therapy of Chronic Liver Disease?

Statins have proven effects in the primary and secondary prevention of coronary disease. Besides lowering LDL-cholesterol beneficial pleiotropic consequences of statin therapy are increasingly discussed. Retrospective analyses of large cohort studies have shown favorable effects on the sequels of chronic viral induced liver disease and of non alcoholic fatty liver disease. These findings are substantiated by experimental work showing that statins reduce inflammation, fibrosis and proliferation in the diseased liver. Prospective controlled trials are necessary to elucidate whether, when and where statins have a role in the therapeutic armamentarium for liver disease.

Comparison of Usefulness of Secondary Prevention of Coronary Disease in Patients

The population older than 80 years is increasing but data on prevention of coronary disease in this age group are sparse. The present study compared the improvement in quality of life, lipid profile, blood pressure, weight, and physical performance after cardiac rehabilitation in patients <80 versus ≥80 years of age. A total of 1,112 patients, of whom 79 were older than 80 years, entered a 36-session outpatient cardiac rehabilitation program after interventions for coronary heart disease. The program consisted of physical exercise, lifestyle modification, and pharmacotherapy. Quality of life improved by 1.3 (95% confidence interval [CI] 0.6 to 2.0) in octogenarians and 1.8 (95% CI 1.5 to 2.1) in younger patients (p= 0.21), whereas weight decreased by 1.7 lbs (95% CI-2.9 to-0.4) and 3.1 lbs (95% CI-3.6 to-2.5, p= 0.04), respectively. In hypertensive patients, systolic blood pressure decreased from 155 ± 11 to 133 ± 20 mm Hg in octogenarians versus 155 ± 13 to 130 ± 20mm Hg in younger patients, reducing the prevalence of hypertension to approximately 10% in both groups. Low-density lipoprotein cholesterol decreased by 16 mg/dl (95% CI-27 to-5) versus 19 mg/dl (95% CI-22 to-16), increasing the percentage of patients at recommended goals from 32% to 46% in the elderly (p= 0.04) and from 18% to 30% in younger patients (p <0.001). Metabolic equivalent levels increased by 1.0 (95% CI 0.7 to 1.3) in octogenarians versus 2.4 (95% CI 2.2 to 2.5) in younger patients (p <0.001). In conclusion, patients ≥80 years of age in an active secondary prevention program derive a significant benefit in well being, risk factors, and exercise capacity and should not be denied such treatment because of age.

Secondary prevention of coronary heart disease in Australia: a blueprint for reform

Authorship statement omitted: In “Secondary prevention of coronary heart disease in Australia: a blueprint for reform” in the 4 February 2013 issue of the Journal (Med J Aust 2013; 198: 70-71), a full statement of authorship was omitted. Julie Redfern and Clara Chow coauthored the editorial on behalf of the Executive Committee and all participants in the National Secondary Prevention of Coronary Disease Summit held in December 2011.

CHANGES IN LIPOPROTEIN INDICATOR AND INDICATOR OF ENDOTHELIAL FUNCTION AFTER IMPLEMENTED CARDIOVASCULAR REHABILITATION PROGRAM

Insufficient physical activity in the world annually is the cause of death of 1.9 million people. According to the data from the World Health Report, physical inactivity is about to become the global problem. Regular physical activity and good physical shape raise the functional capacity and the quality of patient’s life. With physical activity it is possible to improve metabolic, endothelial, lateral-muscular, pulmonary and cardiovascular functions of an organism, but also the function of the autonomous nervous system. The endothelium has the important role in maintaining the normal cardiovascular tonus and blood fluidity by reducing the platelet activity and the adhesion of leukocytes, and also by restricting the reaction of vascular inflammation. The aim of this paper was to present the recent data about effects of cardiovascular rehabilitation and physical training on lipoproteins’ status and markers of endothelial function. The impact of physical activity on the lipid status is accomplished by affecting the enzymes of lipoprotein metabolism, including the lipoprotein and the liver lipase and the movable protein of cholesterol ester (11). The studies point out that aerobic physical activity result in increasing of HDL concentration and the decrease of the triglycerides value, total and LDL cholesterol. The connection, which is dose-dependant, exists between physical activity and the lipid level, as the arguments which suggest that the duration of physical activity is the key parameter in modification of the lipid metabolism. Physical activity leads to the beneficial changes in the cardiovascular and lipid indicators and improves the endothelial function in the secondary prevention of coronary disease. Reduction of the lipid parameters by introducing physical rehabilitation and dietetic regime lie in the basis of secondary prevention of coronary disease. Furthermore, there is a constant improvement in NO biodisposability and therewith the improvement in endothelial function. Acta Medica Medianae 2012;51(3):52-56.

Knowledge of secondary prevention guidelines for coronary heart disease: results from a physicians’ survey in China

There is gap between guideline requirements and clinical practice in coronary disease secondary prevention. A physician's awareness and familiarity are essential to put these guidelines in practice. In 2007 a cross-sectional questionnaire survey was conducted among physicians from cardiology departments in 35 tertiary hospitals in China. The survey instrument contained questions to determine physicians' knowledge of guideline recommendations for coronary heart disease secondary prevention. These included treatment goals for blood pressure, dyslipidaemia and diabetes, lifestyle modifications and medication needs for secondary prevention. The criteria were based mainly on the AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary and Atherosclerotic Vascular Disease (2006). Responses from 837 physicians were deemed effective and were analysed. Knowledge of treatment goals for blood pressure, LDL and HbA1c were 80.8%, 84.2% and 36.2%, respectively; however, only 27.5% of the physicians chose all three goals correctly. Knowledge of lifestyle modification was poor among the physicians as only 2.3% of the physicians correctly answered all five questions about dietary therapy and aerobic exercise goals and requirements. In regard to the six basic questions related to medication, 87% answered correctly. Several specific questions had a much lower rate of being correct, showing that physicians' knowledge was not precise and current. Knowledge of secondary prevention, especially lifestyle modification, for coronary disease was poor among this group of physicians from tertiary hospitals. Efforts must be made to educate physicians to improve their knowledge and improve patient care.

Vodič za sekundarnu prevenciju koronarne bolesti

The implementation guidelines for prevention of the coronary heart disease are measures which are available to the individuals as well as to the entire population. These measures aim to detect the diseases and to conduct faster and more successful medical intervention. More so, these measures are directed against the progression or relapse of disease in patients with an established disease. The secondary prevention of coronary diseases would include the measures which objective is the prevention of relapse and the progression of atherosclerosis in patients who already have an established coronary disease. The modification of the risk factors is the key part of the secondary prevention of coronary disease. The main risk factors remain the important predictors of the long-term prognosis in patients with a coronary disease. The study on conduction of measures for secondary prevention of coronary disease showed high prevalence of bad lifestyle characteristics, other risk factors and insufficient use of prophylactic drugs in coronary disease patients. Inadequate treatment of risk factors in coronary patients is similar in Europe as well as in the other parts of the world.

Secondary Prevention of Coronary Disease with ACE Inhibition-does Blood Pressure Reduction with Perindopril Explain the Benefits in EUROPA?

We determined whether blood pressure (BP) lowering by perindopril was related to its benefit in the EUROPA study. Twelve thousand two hundred eighteen patients with documented coronary artery disease received perindopril 8 mg once daily or matching placebo after a 4-week run-in period in which all patients received perindopril. Patients were excluded if systolic (S) BP was >180 or <100 mmHg. Mean age was 60 years (range 26-89). 27% had a history of hypertension. After 4.2 years of follow-up, the primary endpoint (cardiovascular death, nonfatal myocardial infarction, or resuscitated cardiac arrest) was observed in 603 (9.9%) placebo versus 488 (8.0%) perindopril patients [20% relative risk reduction (RRR), CI 9-29%, P = 0.003]. There was no interaction between baseline SBP levels (using JNC-7 cutoff values) and treatment effect. If anything, the greatest RRR of the primary endpoint (32%) occurred in patients with the lowest SBP (<120 mmHg) in whom perindopril did not reduce SBP. Also, RRR during blinded treatment was comparable, irrespective of whether BP decreased or not or of the extent of BP reduction during perindopril treatment. The treatment benefit in EUROPA cannot be fully explained by baseline BP or BP reduction with perindopril. Other mechanisms including direct anti-atherosclerotic effects of ACE inhibition may play a role.

Pleiotropic effects of statins in inflammation: friend or foe in human arthritis?

The statins (competitive HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower cholesterol and triglycerides and are beneficial in primary and secondary prevention of coronary diseases. Recent studies indicate that statins, while curtailing cholesterol synthesis, exhibit alternate and/or pleiotropic effects attenuating inflammation, oxidative stress, endothelial function and thrombogenic responses. McCarey et al. show beneficial effects of statins on C-reactive protein, erythrocyte sedimentation and joint swelling in rheumatoid arthritis (RA), illustrating a role for statins in inflammation resolution. This paper brings to light several alternate effects of statins, specifically those associated with inflammation resolution and immune modulation, in addition to cardiovascular risks. Although ‘killing two birds with one stone’ is quite appealing, as described by McCarey et al., there are caveats in applying this approach too broadly. Clinical efficacy, long-term safety effects and...

Eficacia de un programa intensivo de prevención secundaria de cardiopatía isquémica tras 5 años de intervención

Most evidence on the efficacy of intensive preventive programs of secondary prevention of coronary diseases comes from Anglo-Saxon countries and effectiveness remains controversial. We have scarce information about the efficacy of these types of programs in Spain. In the present analysis we show the results of the ICAR (Intervención en la Comunidad de Alto Riesgo coronario) study, aimed to analyze the efficacy of an intensive preventive program primary care based in reducing the cardiovascular recurrences and mortality in patients with coronary heart disease. We designed a randomized clinical trial, multicenter and community based, which included 23 health care areas in Catalonia, Spain. We followed for 5 years 2 cohorts of patients with coronary heart disease, aged 30-80 years. The intervention group was quarterly examined by their general practitioner, who adjusted treatments to control their cardiovascular risk factors thoroughly and reinforced life style behaviours. In order to do that, patient's weight and blood pressure were determined in each visit and laboratory test carried out twice a year. Patients in the control group received the usual care. In order to analyze the effect of the intervention cardiovascular recurrences and mortality were registered. We included 983 patients. Mean (standard deviation) age was 64 (10) and 74.5% were men. During the follow-up 235 patients suffered some non-fatal cardiovascular recurrence (109 vs 126 in the control and intervention group, respectively; p = 0.84), and 45 died from cardiovascular recurrences (23 vs 22, respectively; p = 0.57). Adjusted hazard ratio of cardiovascular event and total mortality, for the intervention group were 1.01 (95% confidence interval, 0.74-1.39), and 0.92 (95% confidence interval, 0.54-1.56), respectively. The implementation of an intensive secondary prevention program based on periodical reminds to patients with stable coronary heart disease to attend their general practitioners did not reduce either the cardiovascular recurrences or mortality at 5 years as compared with usual care.

Patterns of Ezetimibe Use in the U.S. and Canada

Ezetimibe, which inhibits intestinal cholesterol absorption, was approved for use in the U.S. and Canada based on its LDL-lowering effects. Because of a lack of evidence that it improves health outcomes, however, ezetimibe has not been recommended for use as a first-line agent for primary or secondary coronary disease prevention. Both ezetimibe and the combination of ezetimibe with simvastatin were aggressively marketed, and — despite the lack of outcomes data — total sales …

The effect of medicamentous and non-medicamentous therapy on lowering risk factors for cardiovascular and cerebrovascular episodes in an interventional study

In a chain of cardiovascular episodes, risk factors (RF) and bad habits represent the first link. The purpose of the study was to determine, during six months, on four examinations (the first, and three follow-ups after the second, fourth and sixth month), the following: physical activity (PA) alteration and the number of cigarettes smoked; the effect of antihypertensive beta-blockers and ACE inhibitors on systolic and diastolic arterial tension; the effect of metmorfin therapy on BMI, glycaemia, total cholesterol level (TCL) and triglycerides in diabetics compared to healthy individuals; the effect of hypolipidaemics on blood TCL and triglycerides in patients with angina pectoris (AP); the effect of betablocker therapy on TCL. This was a multicentric interventional study. Secondary prevention of coronary disease and cerebrovascular conditions was applied in the first half of 2005. There were 185 general practitioners from 38 health centres in Serbia, and patients of both sexes were included with the verified diagnosis of coronary disease and/or cerebrovascular condition. They had demographic data verified as well as data of being genetically (non)predisposed for AP, hypertension, myocardial infarction, stroke and diabetes mellitus. Descriptive and differential statistical methods were used for study result analysis. Out of 1189 patients, there were 51.4% of women and 48.6% of men. The average age was 59.45 +/- 9.77 years. The population was homogeneous by sex and the factor of being genetically (non)predisposed for AP. There was a significant difference in examinations in four contacts in PA and cigarette smoking (p < 0.0001). Systolic and diastolic pressure, TCL and triglycerides were significantly decreased by medicaments (p < 0.05) and more significantly so associated with nonmedicamentous measures (p < 0.001). Metmorfin significantly decreased the glycaemic level (p < 0.001) both in diabetics and patients with a reduced tolerance level to glucose. In patients who took betablockers, there was lowering of TCL. Taking medicaments significantly lowers RF, and more significantly so when associated with a non-medicamentous therapy.

Control de factores de riesgo coronario en prevención secundaria: estudio PRESENAP

Evaluate the overall achievement of goals in the control of risk factors in secondary prevention in patients who have suffered a coronary event and are followed up in primary care centers. Descriptive, transversal, multicenter study with sampling by consecutive inclusion of the first 5 patients attending the doctor's office who had suffered a coronary event 6 months to 10 years previously. The targets for control were: blood pressure < 140/90 mmHg in the general population and < 130/85 mmHg in diabetics; LDL-cholesterol < 100 mg/dl and no smoking habit. 8,817 patients (73.7% males) were included, with a mean (SD) age of 65.4 (10.3) years; 76.6% were hypertensive, 73.4% dyslipidemic and 32.7% diabetics; 60.2% achieved target blood pressure; 26.3% achieved LDL-cholesterol <100 mg/dl and 11.4% continued smoking; 16.4% fulfilled all recommendations. Factors independently related with good control were a lower age, male sex, patients who had been admitted with acute coronary syndrome without ST elevation (OR = 1.39; CI 95%, 1.01-1.93; p = 0.04) or for revascularization (OR = 1.37; CI 95%; 1.12-1.67; p = 0.002), patients with peripheral arterial disease (OR = 1.43; CI 95%, 1.11-1.84; p = 0.005) and when the physicians proposed suitable objectives (OR = 1.90; CI 95%, 1.48-2.44; p < 0.0001). Control was poorer in hypertensive or dyslipidemic patients. Overall control of risk factors in secondary prevention of coronary disease is achieved in one in six patients attending primary care.

Should erectile dysfunction be treated as secondary prevention for coronary disease?

Should erectile dysfunction be treated as secondary prevention for coronary disease?

Randomized controlled trial of an informatics-based intervention to increase statin prescription for secondary prevention of coronary disease

Suboptimal treatment of hyperlipidemia in patients with coronary artery disease (CAD) is well documented. We report the impact of a computer-assisted physician-directed intervention to improve secondary prevention of hyperlipidemia. Two hundred thirty-five patients under the care of 14 primary care physicians in an academically affiliated practice with an electronic health record were enrolled in this proof-of-concept physician-blinded randomized, controlled trial. Each patient with CAD or risk equivalent above National Cholesterol Education Program-recommended low-density lipoprotein (LDL) treatment goal for greater than 6 months was randomized, stratified by physician and baseline LDL. Physicians received a single e-mail per intervention patient. E-mails were visit independent, provided decision support, and facilitated "one-click" order writing. The primary outcomes were changes in hyperlipidemia prescriptions, time to prescription change, and changes in LDL levels. The time spent using the system was assessed among intervention patients. A greater proportion of intervention patients had prescription changes at 1 month (15.3% vs 2%, P=.001) and 1 year (24.6% vs 17.1%, P=.14). The median interval to first medication adjustment occurred earlier among intervention patients (0 vs 7.1 months, P=.005). Among patients with baseline LDLs >130 mg/dL, the first postintervention LDLs were substantially lower in the intervention group (119.0 vs 138.0 mg/dL, P=.04). Physician processing time was under 60 seconds per e-mail. A visit-independent disease management tool resulted in significant improvement in secondary prevention of hyperlipidemia at 1-month postintervention and showed a trend toward improvement at 1 year.

Guidelines for the hormone treatment of women in the menopausal transition and beyond: Position Statement by the Executive Committee of the International Menopause Society

Guidelines for the hormone treatment of women in the menopausal transition and beyond: Position Statement by the Executive Committee of the International Menopause Society

In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis.

Despite multiple randomized trials demonstrating their efficacy for the secondary prevention of coronary disease, lipid-lowering agents remain underused. Few studies have examined the relationship between predischarge initiation of lipid-lowering therapy and long-term use. Using data from patients at 69 centers from the United States and Canada enrolled in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial, we performed a retrospective propensity-analyzed cohort study. Patients underwent percutaneous coronary intervention for stable or recently unstable coronary disease and were older than 21 years, were not taking lipid-lowering therapy at the time of admission, and survived to hospital discharge; 175 were discharged taking lipid-lowering therapy and 1951 were not. After 6 months, 77% of patients who started taking lipid-lowering agents before hospital discharge continued taking therapy, compared with only 25% of those discharged without these agents (relative risk, 3.17; 95% confidence interval, 2.88-3.41; P<.001). After restricting the analysis to propensity-matched patients (n = 477) and adjusting for other potential confounders, initiation of a lipid-lowering agent during hospitalization was the strongest independent predictor of use at 6 months (relative risk, 2.50; 95% confidence interval, 2.29-2.65; P<.001). Inpatient initiation of lipid-lowering therapy is a strong and independent positive predictor of subsequent use, with patients who start taking lipid-lowering therapy before hospital discharge nearly 3 times as likely to be taking these agents 6 months later. Inpatient initiation of lipid-lowering therapy appears to be an effective strategy for bridging the gap between current medical knowledge and practice.