A BRITISH-CARDIAC-SOCIETY SURVEY OF THE POTENTIAL FOR THE SECONDARY PREVENTION OF CORONARY-DISEASE - ASPIRE (ACTION ON SECONDARY PREVENTIONTHROUGH INTERVENTION TO REDUCE EVENTS) - PRINCIPAL RESULTS

Objective-To measure the potential for secondary prevention of coronar y disease in the United Kingdom. Design-Cross sectional survey of a re presentative sample of coronary patients from a retrospective review o f hospital medical records and patient interview and examination. Sett ing-Stratified random sample of 12 specialist cardiac centres and 12 d istrict general hospitals drawn from 34 specialist cardiac centres and 261 district general hospitals in 12 geographic areas in the United K ingdom. Subjects-2583 patients less than or equal to 70 yr; 25 consecu tive males and 25 consecutive females identified retrospectively in ea ch of four diagnostic categories: coronary artery bypass grafting, per cutaneous transluminal coronary angioplasty, acute myocardial infarcti on, and acute myocardial ischaemia without evidence of infarction. Mai n outcome measures-Risk factor recording and management in medical rec ords; the prevalence and control of risk factors at interview six mont hs after the procedure or event. Results-Recording of coronary risk fa ctors in patient's records was incomplete and this varied by risk fact or. Smoking habit and blood pressure were most completely recorded, wh ereas a history of hyperlipidaemia and blood cholesterol concentration s were least complete. Risk factor records were more likely to be comp lete in cardiac centres than in district hospitals. At interview 10% t o 27% of patients were still smoking cigarettes and 75% remained overw eight, females more severely so. Up to a quarter of patients remained hypertensive, males more severely so than females. Over three quarters had a total cholesterol > 5.2 mmol/l. In patients on medication for b lood pressure, cholesterol or glucose, risk factor profiles were Littl e better than in those who were not. Only about one patient in three w as taking a beta blocker after infarction. Up to a fifth of patients w ho had had acute myocardial ischaemia were not taking aspirin at follo w up. Conclusions-There is considerable potential to reduce the risk o f a further major ischaemic event in patients with established coronar y disease. This can be achieved by effective lifestyle intervention, t he rigorous management of blood pressure and cholesterol, and the appr opriate use of prophylactic drugs.