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Risk factors in established coronary heart disease: evaluation of a secondary prevention programme
1Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden. thomas.kahan@med.ds.sll.se
Insights
Coronary heart disease patients often have modifiable risk factors, with few achieving lipid goals. Secondary prevention programs help, but further education is needed for better outcomes in managing heart disease.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality in developed nations.
- Secondary prevention programs aim to manage CHD and its risk factors.
- This study investigates patient compliance and gender-specific differences within a CHD secondary prevention program.
Purpose of the Study:
- To assess the adherence and effectiveness of a secondary prevention program for coronary heart disease (CHD) patients.
- To identify potential gender-based disparities in the management of CHD risk factors and treatment adherence.
- To evaluate the achievement of therapeutic goals for various cardiovascular risk factors.
Main Methods:
- A cross-sectional survey was conducted among 760 CHD patients (up to 75 years old).
- Patients were recruited from hospital cardiology outpatient clinics and primary care centers.
- Data were collected via questionnaires administered by cardiologists and primary care physicians.
Main Results:
- Therapeutic goal achievement varied: 29-36% for cholesterol, 42-50% for triglycerides, 66-72% for blood glucose, 84-86% for blood pressure, and 16-20% for smoking cessation.
- Hospital care patients were more likely to undergo echocardiography (OR 2.69).
- Men received more echocardiograms (OR 2.59) and specific medications like ACE-inhibitors (OR 2.04) and beta-blockers (OR 1.82), while women were more often prescribed diuretics (OR 0.49).
Conclusions:
- CHD patients exhibit a high prevalence of modifiable risk factors, with suboptimal control of lipid levels.
- While secondary prevention programs are beneficial, enhanced educational strategies are necessary to improve patient outcomes.
- Addressing gender-specific patterns in treatment and risk factor management is crucial for optimizing CHD care.
Background:
Coronary heart disease (CHD) is the leading cause of death in the developed world. We studied compliance to a secondary prevention programme for CHD patients and possible gender differences.
Design And Methods:
Cross-sectional survey of CHD patients aged up to 75 years attending a hospital cardiology outpatient clinic (n = 441; 16 cardiologists) and 12 primary care centres (n = 319; 28 primary care physicians), by means of a questionnaire.
Results:
Therapeutic goals in hospital care and in primary care were reached by 36% and 29% (P < 0.05) for cholesterol, 42% and 50% (P < 0.01) for triglycerides, 66% and 72% for blood glucose, 84% and 86% for blood pressure, and 16% and 20% for smoking, respectively. Echocardiography was more frequent in hospital care patients (odds ratio 2.69, P < 0.001). ACE-inhibitors, beta-blockers, antiplatelet and anticoagulant therapy were prescribed similarly in both groups, antidiabetics were less common in hospital care (odds ratio 0.53, P < 0.05). Men were more often subject to echocardiography (odds ratio 2.59, P < 0.001). ACE-inhibitors (odds ratio 2.04, P < 0.01), beta-blockers (odds ratio 1.82, P < 0.001) and antiplatelet or anticoagulant drugs (odds ratio 1.82, P < 0.01) were more common in men; diuretics (odds ratio 0.49, P < 0.01) were more common in women.
Conclusions:
CHD patients have a high prevalence of modifiable risk factors. Few reach therapeutic goals for lipid levels, whereas other risk factors are better controlled. A secondary prevention programme is an important aid in preventing CHD but must be followed by further educational efforts in order to be more effective.
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