Suboptimal control of cardiovascular risk factors in myocardial infarction survivors in a cardiac rehabilitation program

As short-term mortality continues to decrease after myocardial infarction (MI), secondary prevention strategies attain increasing relevance. This study aimed at assessing the control of cardiovascular (CV) risk factors, including dyslipidemia, hypertension and diabetes, in a contemporary cohort of MI survivors who completed an exercise-based cardiac rehabilitation (EBCR) program. Observational, retrospective cohort study including patients admitted to a tertiary center with acute MI between November 2012 and April 2017, who completed a phase II EBCR program after discharge. Achievement of low-density lipoprotein (LD) cholesterol, blood pressure and HbA1c guideline recommended targets was assessed. Lipid profile parameters were assessed and compared at three time points (hospitalization, beginning and end of the program). A total of 379 patients were included. Mean age was 58.8±10.6 years; 81% were male. Considering the European Society of Cardiology's guidelines on contemporary data collection, 61%, 87% and 71% achieved the recommended LDL cholesterol, blood pressure and HbA1c targets, respectively, at the end of the program. Combining all three risk factors, 42% achieved the recommended targets. High-sensitivity C-reactive protein decreased between the beginning and the end of the program [0.14 (0.08-0.29) mg/L to 0.12 (0.06-0.26) mg/L; p<0.001]. Despite contemporary management strategies, including enrollment in a structured EBCR program, a substantial number of patients presented suboptimal control of CV risk factors. Considering the dyslipidemia, hypertension and diabetes results, less than half of the enrolled individuals achieved the recommended targets. These findings highlight a pivotal unmet need which could be particularly relevant in improving CV outcomes by enhancing secondary prevention profiles. À medida que a mortalidade após enfarte agudo do miocárdio (EAM) diminui, as estratégias de prevenção secundária adquirem uma relevância crescente. O objetivo deste estudo foi avaliar o controlo de fatores de risco cardiovascular (FRCV), nomeadamente dislipidemia, hipertensão e diabetes mellitus, em doentes após EAM que completaram um programa de reabilitação cardíaca (PRC). Estudo de coorte retrospetivo, observacional, que incluiu doentes admitidos num centro terciário com o diagnóstico de EAM, entre novembro de 2012 e abril de 2017. Foi avaliado o atingimento dos alvos recomendados pelas guidelines da Sociedade Europeia de Cardiologia para colesterol LDL (LDLc), pressão arterial (PA) e hemoglobina glicada (HbA1C). Os parâmetros lipídicos foram avaliados e comparados em três momentos (hospitalização, início e fim do programa). Foram incluídos 379 doentes (58,8±10,6 anos, 81% homens). Considerando as guidelines, 61%, 87% e 71% atingiram os alvos recomendados de LDLc, PA e HbA1c, respetivamente, no fim do programa. Combinando os três FRCV, 42% dos indivíduos atingiram os alvos recomendados. Os níveis de proteína C reativa de alta sensibilidade diminuíram entre o início e o fim do programa [0,14 (0,08-0,29) mg/L versus. 0,12 (0,06-0,26) mg/L; p<0,001]. Apesar de estratégias contemporâneas, incluindo a participação num PRC, uma proporção importante de doentes apresentou um controlo subótimo dos FRCV. Considerando dislipidemia, hipertensão e diabetes mellitus combinados, menos de metade atingiu os alvos recomendados. Estes dados reforçam a importância da otimização de estratégias de prevenção secundária, dado o potencial impacto em outcomes cardiovasculares.