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Healthy Behavior, Risk Factor Control, and Survival in the COURAGE Trial.

David J Maron1, G B John Mancini2, Pamela M Hartigan3

  • 1Department of Medicine, Stanford University, Stanford, California.

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|November 3, 2018
PubMed
Summary
This summary is machine-generated.

Achieving multiple risk factor control significantly improves survival for patients with stable ischemic heart disease (SIHD). Comprehensive management of factors like blood pressure and smoking is key to better outcomes.

Keywords:
guideline-directed medical therapylifestyleoptimal medical therapysecondary preventionstable ischemic heart disease

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Area of Science:

  • Cardiology
  • Preventive Medicine
  • Public Health

Background:

  • Individual risk factor control enhances survival in stable ischemic heart disease (SIHD) patients.
  • The impact of multiple risk factor control on SIHD patient survival remains uncertain.

Purpose of the Study:

  • To determine if achieving a greater number of risk factor goals predicts improved survival in SIHD patients.
  • Investigate the association between comprehensive risk factor management and mortality in SIHD.

Main Methods:

  • Analysis of 2,102 participants from the COURAGE trial with complete data on 6 risk factors (blood pressure, LDL cholesterol, smoking, physical activity, diet, BMI).
  • Interventions were applied to control these risk factors, with mortality as the primary outcome measure.
  • Follow-up averaged 6.8 years.

Main Results:

  • Higher number of controlled risk factors correlated with increased survival probability (univariate analysis, p < 0.001).
  • Key predictors of survival at 1 year included non-smoking status, physical activity, systolic blood pressure <130 mmHg, and adherence to AHA Step 2 diet.
  • Controlling 4 to 6 risk factors significantly lowered mortality risk compared to controlling 0 to 1 risk factor (HRs 0.64 and 0.27, respectively).

Conclusions:

  • Greater control over multiple risk factors is associated with higher survival rates in SIHD patients.
  • Developing enhanced strategies for comprehensive risk factor control, emphasizing healthy behaviors, is crucial for improving patient outcomes.