Secondary Prevention of Acute Coronary Syndrome. Socio-economic and Lifestyle Determinants: A Literature Review

Abstract

Although cardiovascular disease mortality rates seem to decline, especially among middle-aged people in developed countries, the prevalence of acute coronary syndrome (ACS) increases, representing the most common cause of morbidity in both developed and developing countries and generating large economic burden. It is estimated that one fifth of the ACS patients die suddenly and half of them belong to a fast growing popula- tion age-group, i.e., those between 70 and .80 years. A substantial number of these deaths has been attributed to various lifestyles, modifiable factors; therefore, it can be prevented. However, factors such as dietary habits and behaviours, physical activity, life stress and smoking habits, although thoroughly discussed, are not well understood and appreciated in the spectrum of secondary ACS prevention. The latter deserves further attention under the prism of socio-economic status that has changed dramatically in the last years in some populations. The aim of this review was to discuss the role of lifestyle factors on secondary ACS prevention under the prism of individual's socio-economic status. Based on the retrieved information it was revealed that there is vast evidence that secondary prevention of cardiovascular events cannot be accomplished simply through medical treatment, but it requires a multifaceted approach incorporating lifestyle modifications, too. Therefore, public health policy endeavours should be directed towards multifocal strategies, i.e., to motivate and support cardiac patients to consistently follow treatment regimens and to establish more effective and efficient community lifestyle interventions.

Ethnic differences in sleep duration and morning–evening type in a population sample

“…While the causal association between sleep duration and morning–evening type with the cardiometabolic diseases cannot be examined in these cross-sectional data, we can hypothesize about the complex interplay of variables linking sleep with cardiometabolic health. A growing movement in the chronic disease field is the clustering of health risk behaviors and the scientific acknowledgement that cardiovascular diseases, such as angina, are the product of several modifiable risk behaviors (Jensen et al, 2008; Notara et al, 2014). The American Heart Association’s “heart score” is a clinical representation of this line of work that defines risk of cardiovascular events based on obesity, tobacco use, dietary behavior and physical activity behaviors (American Heart Association, 2015; Eckel et al, 2014).…”

Socioeconomic status predicts second cardiovascular event in 29,226 survivors of a first myocardial infarction

“…11 However, surprisingly few studies address the association between SES and subsequent events in secondary prevention. [12][13][14][15] In particular, no previous study has investigated the association between a patient's income and/or educational level with recurrent hard CVD events in MI survivors or whether an association between SES and recurrent CVD is mediated by differences in received secondary preventive treatment. With a near completely tax financed healthcare system and access to high quality national registries with high validity, [16][17][18] the prerequisites for observational SES studies on recurrent CVD are favourable in Sweden.…”

An Assessment of Specialist Physician Referral Practices for Long-Term Cardiovascular Risk Reduction in the Community: Are We Using Our Available Resources?

“…It is well established that decreasing the number and severity of modifiable risk factors (MRF) can have a large impact on primary prevention of CVD, 2,4-7 as well as secondary prevention and mitigation of established CVD. [8][9][10] Modifiable risk factors include: obesity, diabetes mellitus, hypertension, smoking, dyslipidemia, obstructive sleep apnea, lack of exercise and stress. 2,6,11 Cardiovascular risk reduction (CRR) programs address modifiable risk factors and have demonstrated appreciable reductions in morbidity and mortality from CVD.…”