[Cardiovascular morbimortality reduction after an acute cardiovascular event through multifactorial and intensive cardiovascular risk factors management (MIRVAS project)].
OBJECTIVE
In spite of publication of many guidelines, management of patients on secondary prevention of cardiovascular disease is still not appropriated. We design a randomized trial, in usual clinical practice conditions, to compare the results in cardiovascular morbimortality of intensive and integral management of cardiovascular risk factors (CVRF) management versus conventional care.


METHODS
We selected patients discharged between October 2002 and January 2004 who suffered an acute coronary syndrome with or without ST-segment elevation or a stroke, 247 patients that met inclusions criteria were randomized to intensive care of CVRF in a specific Internal Medicine outpatient clinic (n = 121) or usual care according to National Health Service recommendations (n = 126). A year after randomization, the percentage of patients who met CVRF control, treatment received and the number of cardiovascular events (cardiovascular death, acute coronary syndrome with or without ST-segment elevation, stroke, transient ischemic attack, revascularization, lower limb amputation, heart failure admission and sudden death) were revised.


RESULTS
CVRF control was greater in patients assigned to intensive care. 74.1% of hypertensive patients assigned to this treatment were controlled vs 41.7% in the usual care group (relative risk [RR] = 1.78; 95% confidence interval [CI], 1.27-2-49); 70.2% of patients had low-densi-tiy lipoprotein cholesterol lower than 100 mg/dl vs 55.8% (RR = 1.26; 95% CI, 1.00-1.58) of patients in usual care group; 93.1% of diabetic patients had glycosylated haemoglobin lower than 7% vs. 57.1% (RR = 1.63; 95% CI, 1.11-2.39) in the usual care group. There were 12 cardiovascular events in the intensive care group vs 35 in the usual care group.


CONCLUSIONS
Intensive management of CVRF leads to a better control of them and a reduction of the morbimortality one year after an acute cardiovascular event.
Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España. MIGUEL_MO@telefonica.net
Miguel Angel
MA
Moreno Palanco
Cristina
C
Ciria de Pablo
Patricia
P
Ibáñez Sanz
Carlos
C
Sánchez Luis
Alberto
A
Pizarro Portillo
Carmen
C
Suárez Fernández
D000208:Acute Disease; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality; D003422:Critical Care / Q000379:methods*; D003645:Death, Sudden; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors