Lifestyle and physiological risk factor profiles six weeks after an acute cardiac event: are patients achieving recommended targets for secondary prevention?
ABSTRACT People who have had a cardiac event are at increased risk of a subsequent event and death and are, therefore, the priority for preventive cardiology in Australia and elsewhere. Guidelines for physiological and lifestyle risk factors have been developed to encourage risk reduction as a means of secondary prevention. The aim of the present study was to investigate achievement of recommended risk factor targets in a sample of Australian cardiac patients.
A consecutive sample of 275 patients admitted to one of two Melbourne hospitals after acute myocardial infarction (AMI; 32%) or for coronary artery bypass graft surgery (CABGS; 40%) or percutaneous coronary intervention (PCI; 28%) participated in risk factor screening approximately five weeks after hospital discharge. The 2007 National Heart Foundation (NHF) of Australia 'Guidelines for Reducing Risk in Heart Disease' (1) and the 2001 NHF and Cardiac Society of Australia and New Zealand lipid management guidelines (2) were used to define risk factor targets. Target achievement was compared for AMI, CABGS and PCI patients.
Patients ranged in age from 32 to 75 years (mean=59.0; SD=9.1). Most (86%) were male. Almost three quarters of the patients were above recommended targets for waist girth (70%) and almost half were above targets for blood pressure (48%) and below target for high density lipoprotein cholesterol (47%). Around a quarter were over target for total cholesterol (27%) and under target for physical activity (27%). Most patients met the NHF guidelines of non-smoking (95%) and restricted alcohol consumption (88%). For several risk factors, PCI patients were at greater risk of not achieving recommended targets than either CABGS or AMI patients.
Six weeks after an acute cardiac event, substantial proportions of Australian patients do not achieve recommended targets for waist girth, blood pressure, total cholesterol, physical activity, and HDL cholesterol. PCI patients are particularly at risk. Considerable potential remains for improving risk factor management in CHD patients, highlighting the important role of general practitioners, outpatient cardiac rehabilitation and other secondary prevention strategies.
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ABSTRACT: Despite guidelines, a 'treatment gap' exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyse the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005-2010). The MIG registry prospectively collects demographic, clinical and procedural characteristics of consecutive patients undergoing PCI. We assessed medication use (aspirin, clopidogrel, ACE-inhibitors, angiotensin-receptor blockers, beta-blockers and lipid-lowering agents) at 30 days and 12 months in patients alive and able to provide the information. The cohort consisted of 12,813 patients who underwent 14,787 consecutive interventional procedures. They comprised 76% males; 22% were elderly (≥75years), 23% had diabetes, 2% had severe renal impairment, 2% had severe left ventricular dysfunction, 26% presented with STEMI, and 44% of patients received DES. Follow-up was complete for 97.8% of the cohort at 30 days (2.2% mortality) and 89.1% at 12 months (4.0% mortality). From 2005-2010, the percentage of patients taking all 5 classes of medications increased each year. In 2010 at 30 days, nearly 60% of patients took all 5 classes of medications and by 12 months 75% of patients were taking 4 or 5 classes of medications. In Conclusion whilst the increasing use of cardiovascular medicines in an 'at risk' Australian cohort is encouraging, a treatment gap appears to still exist. This article is protected by copyright. All rights reserved.Cardiovascular Therapeutics 01/2014; · 2.85 Impact Factor
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ABSTRACT: Non-communicable diseases such as cancer, atherosclerosis and diabetes are responsible for major social and health burden as millions of people are dying every year. Out of which, atherosclerosis is the leading cause of deaths worldwide. The lipid abnormality is one of the major modifiable risk factors for atherosclerosis. Both genetic and environmental components are associated with the development of atherosclerotic plaques. Immune and inflammatory mediators have a complex role in the initiation and progression of atherosclerosis. Understanding of all these processes will help to invent a range of new biomarkers and novel treatment modalities targeting various cellular events in acute and chronic inflammation that are accountable for atherosclerosis. Several biochemical pathways, receptors and enzymes are involved in the development of atherosclerosis that would be possible targets for improving strategies for disease diagnosis and management. Earlier anti-inflammatory or lipid-lowering treatments could be useful for alleviating morbidity and mortality of atherosclerotic cardiovascular diseases. However, novel drug targets like endoglin receptor, PPARα, squalene synthase, thyroid hormone analogues, scavenger receptor and thyroid hormone analogues are more powerful to control the process of atherosclerosis. Therefore, the review briefly focuses on different novel targets that act at the starting stage of the plaque form to the thrombus formation in the atherosclerosis.Saudi Pharmaceutical Journal 01/2014; 22(3):179–190. · 0.95 Impact Factor
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ABSTRACT: The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n = 71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis. About 60 % of the people had no history of ischemic heart disease before the out-of-hospital cardiac arrest, but 20 % had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus, total cholesterol of more or equal 5 mmol/l or taking lipid lowering medication, and current smoker). Three categories (i.e., significance of lifestyle, modifying the lifestyle to the new life situation and a changed view on life) and seven sub-categories emerged from the qualitative analysis. For many people out-of-hospital cardiac arrest was the first symptom of coronary heart disease. Interview participants were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some chose to ignore this knowledge to some extent and preferred to live a "good life", where risk factor treatment played a minor part. The importance of the support of family members in terms of feeling happy and having fun was highlighted by the interview participants and expressed as being the meaning of lifestyle. Perhaps the person with illness together with health care workers should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours linked to these things.BMC Cardiovascular Disorders 08/2013; 13(1):62. · 1.46 Impact Factor