RISK INDICATORS FOR RECURRENCE AMONG PATIENTS WITH CORONARY-ARTERY DISEASE - PROBLEMS ASSOCIATED WITH THEIR MODIFICATION

Various risk indicators associated with recurrence of a new ischemic e vent among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on suc h risk indicators is evaluated. At Sahlgrenska Hospital in Goteborg, 2 93 consecutive patients under the age of 70 years were followed for on e to two years after an acute myocardial infarction (AMI), coronary ar tery bypass grafting (CABG), or percutaneous transluminal coronary ang ioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospi tal. A secondary preventive nurse was appointed and guidelines for ris k factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or tri glycerides > 3.0 mmol/l. The mean value for low density lipoprotein (L DL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first scre ening to 26% at second screening (p < 0.01) It was found that 70% of a ll the patients had one or more of the following risk indicators at th e first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8% ) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicato rs in patients, even with the aid of health-care professionals, in ord er to achieve risk-factor reduction in coronary artery disease.