Risk indicators for recurrence among patients with coronary artery disease -: Problems associated with their modification

Various risk indicators associated with recurrence of a new ischemic event among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on such risk indicators is evaluated. At Sahlgrenska Hospital in Goteborg, 293 consecutive patients under the age of 70 years were followed for one to two years after an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospital. A secondary preventive nurse was appointed and guidelines for risk factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or triglycerides > 3.0 mmol/l. The mean value for low density lipoprotein (LDL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first screening to 26% at second screening (p < 0.01) It was found that 70% of all the patients had one or more of the following risk indicators at the first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8%) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicators in patients, even with the aid of health-care professionals, in order to achieve risk-factor reduction in coronary artery disease.