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[Cardiovascular prevention, primary or secondary, in high risk patients]
1Unité 258 INSERM, hôpital Broussais, Paris.
Insights
Cardiovascular disease prevention advice is more frequently followed in secondary prevention patients. However, risk factor monitoring and adherence to lifestyle changes remain suboptimal across both primary and secondary prevention groups, indicating a need for improved organization.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Coronary artery disease (CAD) management involves preventive strategies.
- Patient adherence to cardiovascular prevention advice varies significantly.
- Understanding differences in prevention uptake between primary and secondary prevention is crucial.
Purpose of the Study:
- To evaluate the advice received and followed for cardiovascular prevention in patients with coronary artery disease.
- To compare the effectiveness of primary versus secondary prevention strategies in patient adherence and risk factor management.
- To identify gaps in the diagnosis and follow-up of cardiovascular risk factors.
Main Methods:
- Consecutive patients admitted for coronary artery disease were divided into two groups: primary prevention (disease < 1 month) and secondary prevention (disease > 6 months).
- Interrogation focused on cardiovascular prevention advice received and followed, including dietary changes and treatments.
- Analysis included the follow-up of risk factors like serum cholesterol and glucose levels.
Main Results:
- Secondary prevention patients showed higher compliance with medical advice and better follow-up of risk factors compared to primary prevention patients.
- Diagnosis and follow-up of risk factors were incomplete in both groups, with significant percentages of unmeasured cholesterol and glucose levels.
- While prevention measures were advised to a majority of patients, compliance with diet and cholesterol-lowering drugs was mediocre, with many patients exceeding recommended levels.
Conclusions:
- Cardiovascular prevention strategies require better organization to improve patient outcomes.
- Despite better adherence in secondary prevention, overall management of risk factors and patient compliance needs enhancement.
- The study highlights the need for systematic and comprehensive approaches to cardiovascular risk factor management in clinical practice.
Abstract:
Two groups of patients admitted to hospital consecutively for coronary artery disease in 36 university hospital departments were interrogated about the advice received and followed concerning cardiovascular prevention both before the clinical onset of the disease (Group I), those with disease of less than one month duration (primary prevention), or after this period (Group II), those with disease for over six months (secondary prevention). The follow-up of risk factors or medical advice concerning prevention (dietary and/or treatment) was more common, and compliance to the advice was better, in secondary prevention. However, in both groups, with the exception of hypertension, the diagnosis and follow-up of the risk factors were incomplete with 19% vs 41% (p < or = 0.001) of serum cholesterol levels unmeasured before the onset of clinical disease; during the last 5 years, 41% vs 12% (cholesterol, p < or = 0.001) and 27% vs 9% (serum glucose, p < or = 0.001) were not checked. At least one measure of prevention had been advised to 66% vs 80% (p < or = 0.001) of patients and the measures taken concern 53 vs 75% (p < or = 0.001) of patients: serum cholesterol 27% vs 51% (p < or = 0.001), hypertension 32% vs 36% (NS) and serum glucose 14% vs 21% (p < or = 0.05). Compliance with advice was mediocre with regards to diet and cholesterol lowering drugs. A large proportion of patients in both groups had higher than recommended levels, including those on diet or treatment. These observations, confirmed in France and abroad, suggest that cardiovascular prevention should be better organised.
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