Risk Factors in Established Coronary Heart Disease: Evaluation of a Secondary Prevention Programme

BACKGROUND: Coronary heart disease (CHD) is the leading cause of death in the developed world. We studied compliance to a secondary prevention programme for CHD patients and possible gender differences. DESIGN AND METHODS: Cross-sectional survey of CHD patients aged up to 75 years attending a hospital cardiology outpatient clinic (n = 441; 16 cardiologists) and 12 primary care centres (n = 319; 28 primary care physicians), by means of a questionnaire. RESULTS: Therapeutic goals in hospital care and in primary care were reached by 36% and 29% (P < 0.05) for cholesterol, 42% and 50% (P < 0.01) for triglycerides, 66% and 72% for blood glucose, 84% and 86% for blood pressure, and 16% and 20% for smoking, respectively. Echocardiography was more frequent in hospital care patients (odds ratio 2.69, P < 0.001). ACE-inhibitors, beta-blockers, antiplatelet and anticoagulant therapy were prescribed similarly in both groups, antidiabetics were less common in hospital care (odds ratio 0.53, P < 0.05). Men were more often subject to echocardiography (odds ratio 2.59, P < 0.001). ACE-inhibitors (odds ratio 2.04, P < 0.01), beta-blockers (odds ratio 1.82, P < 0.001) and antiplatelet or anticoagulant drugs (odds ratio 1.82, P < 0.01) were more common in men; diuretics (odds ratio 0.49, P < 0.01) were more common in women. CONCLUSIONS: CHD patients have a high prevalence of modifiable risk factors. Few reach therapeutic goals for lipid levels, whereas other risk factors are better controlled. A secondary prevention programme is an important aid in preventing CHD but must be followed by further educational efforts in order to be more effective.