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.


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.
Kahan
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Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Danderyd, Sweden. thomas.kahan@med.ds.sll.se
Wändell
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D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology