Assessment of the Efficacy of Secondary Prevention in Patients with Coronary Artery Disease

The aim of study was to assess the efficacy of secondary prevention in patients with coronary artery disease in a cardiology center, investigating prevalance of modifiable risk factors a year after hospitalisation. Two-hundred and seventy-three consecutive patients (age 28-70 years, m ean age: 56± 10, 80% men) hospitalised in 1996, were identified retrospectively with the following diagnosis: AMI (85 patients), PTCA (96 patients) and CABG (92 patients). Data co lleeti on was conducted in two stages: 1) A retrospective review of hospital medical records 2) An interview and examination of the patients one year later. History of cigarette smoking, height, weight, blood pressure and lipid measurements, physical activity status, global cardiac risk and medications at discharge were abstracted from the hospital records, and the same information and measurements were determined at Ieast one year (mean follow-up time: 16±2 months) after the index event or intervention. At the time of the index event, 55% of patients smoked cigarettes, 40% were overweight (Body mass index ? 30kg/m2), 43% had elevated systolic (? 140 mm Hg), 26% had elevated diastolic (? 90 mm Hg) blood pressure, 61% had high low density lipoprotein cholesterol (LDL-C) ? 130 mg/dL. At the time of interview, done at least a year after the index event, 19% of the patients smoked, 37% were overweight, 45% had high systolic (? 140 mm Hg), 33% had high diastolic (? 90 mm Hg) blood pressure, LDL-C was ? 130 mg/dl in 38%, 15% of patients were not on lipid lowering drugs although indicated according to national guidelines. In patients on lipid lowering drugs, LDL-C was found to be > 130 mg/di in 49%. Fortyseven percent of patients reported that they do not exercise regularly. Secondary prevention efforts in terms of achieving target LDL-C level were found to be most succesful in PTCA patients. At interview, 93% of all patients were on Aspirin, of patients with previous MI, 14% and 19% were on beta-blockers and ACE-inhibitors, respectively. Global risk was found to be diminished one level in 23% of all patients. It is concluded that, there is a considerable potential for physicians to further improve the iınplementation of secondary prevention of coronary artery disease, even in a cardiology clinic, where the education and knowledge of physicians regarding coronary risk reduction are assumed to be highest.