Secondary prevention in myocardial infarction patients with known coronary artery disease
Jarle Jortveit1, John Munkhaugen2, Anete Kaldal3
1Medisinsk avdeling, Sørlandet sykehus Arendal.
Insights
Secondary prevention in coronary artery disease (CAD) patients after myocardial infarction is crucial. This study found that while some treatments improved, blood pressure control worsened, highlighting the need for better secondary prevention strategies in Norway.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Secondary preventive treatment is vital for patients with known coronary artery disease (CAD) to reduce cardiovascular events.
- This study assesses the achievement of secondary prevention treatment targets in CAD patients admitted with acute myocardial infarction (MI).
Purpose of the Study:
- To evaluate the extent to which patients with known CAD admitted for acute MI met secondary prevention treatment goals.
- To identify trends in secondary prevention metrics over a 10-year period in Norway.
Main Methods:
- Utilized data from the Norwegian Myocardial Infarction Registry.
- Included patients under 85 years with known CAD admitted for type 1 MI between January 2013 and December 2022.
Main Results:
- Out of 22,825 eligible patients, 24.4% were women; median age was 72.
- Antiplatelet/anticoagulant therapy increased (88% to 91%), but healthy weight decreased (33% to 29%).
- Lipid-lowering therapy remained stable (77%), with low LDL cholesterol (<1.8 mmol/L) in 21%. Blood pressure control (<140/90 mmHg) significantly decreased from 43% to 30%.
Conclusions:
- Despite improvements in some areas like antiplatelet therapy, secondary prevention targets are not consistently met.
- The decline in blood pressure control is a significant concern.
- There is a clear need for improved secondary preventive measures for CAD patients in Norway.
Background:
Secondary preventive treatment for patients with known coronary artery disease reduces the risk of new cardiovascular events. We studied the extent to which patients with known coronary artery disease who were admitted with acute myocardial infarction had achieved the treatment targets for secondary prevention.
Material And Method:
The study used data from the Norwegian Myocardial Infarction Registry and included patients below the age of 85 years with known coronary artery disease who were admitted with type 1 myocardial infarction to Norwegian hospitals in the period from 1 January 2013 to 31 December 2022.
Results:
Out of 74,993 patients below the age of 85 years who were admitted with type 1 acute myocardial infarction, 22,825 (30.4 %) had known coronary artery disease. Of these patients, 24.4 % were women and the median age was 72 years (interquartile range 64-78). The proportion with known coronary artery disease was stable during the study period. The proportion of non-smokers increased from 71 % to 75 % (+0.7 % per year), the proportion of patients with a healthy weight decreased from 33 % to 29 % (-1.8 % per year), and the proportion receiving antiplatelet and/or anticoagulant therapy increased from 88 % to 91 % (+0.3 % per year). The proportion receiving lipid-lowering therapy (77.0 %) and the proportion who had LDL cholesterol < 1.8 mmol/L (21 %) was stable. The proportion of patients with blood pressure < 140/90 mmHg decreased from 43 % to 30 % (-4.6 % per year until 2020, then unchanged).
Interpretation:
The study demonstrates the need for measures to improve secondary preventive treatment in patients with coronary artery disease in Norway.
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