Long-Term Risk Factor Control After Myocardial Infarction—A Need for Better Prevention Programmes

Abstract

Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on health care data regarding RFC after MI and presents recent trials on modern preventive strategies that support patients to achieve risk factor targets during long-term course. Results: International registry studies, such as EUROASPIRE, observed alarming deficiencies in RFC after MI. As data of the German Bremen ST-segment elevation myocardial infarction (STEMI)-Registry show, most deficiencies are found in socially disadvantaged city districts and in young patients. Several studies on prevention programmes to improve RFC after MI reported inconsistent data; however, in the recently published IPP trial a 12-months intensive prevention programme that included both repetitive personal contacts with non-physician prevention assistants and telemetric risk factor control, was associated with significant improvements of numerous risk factors (smoking, LDL and total cholesterol, systolic blood pressure and physical inactivity). Conclusions: There is a strong need of action to improve long-term risk RFC after MI, especially in socially disadvantaged patients. Modern prevention programmes, using personal and telemetric contacts, have large potential to support patients in achieving long-term risk factor targets after coronary events.

Long-term prevention after myocardial infarction in young patients ≤45 years: the Intensive Prevention Program in the Young (IPP-Y) study

“…However, the intensive prevention programme IPP-Y was associated with a significant improvement of risk factor control in young MI patients. The effects of the programme were similar compared to a cohort of older patients (≤75 years) that our study group had investigated in a previous trial, 7,8 or to results that have been reported by other prevention programmes in older patients. 9 Although it might be assumed that young patients focus on business and families and do not find time for preventive activities, our data show that prevention programmes can be effective even in young MI patients.…”

Integrated cardiovascular risk management programme versus usual care in patients at high cardiovascular risk: an observational study in general practice

“…Finally, modernisation of prevention programmes, for example by a more continuous telemetric risk factor control, may be promising. 8 * As the response rate in the intervention group was lower than the expected 70%, we did not reach the required sample size after we invited 587 intervention patients. Therefore we had to invite 226 extra patients in the intervention group (totally invited n = 813) and matched them retrospectively to the usual care group.…”

“…7 So far, studies on the effectiveness of CVRM programmes are scarce and the available evidence is inconsistent. [8][9][10] Some studies showed a trend towards improved lifestyle, but did not show an effect on cardiovascular risk factors and cardiovascular outcomes. [11][12][13] However, the studies were heterogeneous in design, target population and interventions tested and adequate comparison with usual care was often lacking.…”

Synthesizing secondary data into survival analysis to improve estimation efficiency

“…The ARIC study was aimed originally at assessing the risk factors of atherosclerosis and its clinical outcomes, namely the trends in rates of coronary heart disease and hospitalized MI among men and women aged 45–64 (González et al., 2018; Investigators, 1989). In clinical practice, detecting risk factors of MI is crucial for disease prevention and selecting treatment that is more cost‐effective (Osteresch et al., 2019). Therefore, our goal here is to investigate the effects of potential clinical and demographic features on the MI risk with the outcome as the time to hospitalization of acute MI since enrollment.…”