title: Impact of comprehensive and intensive treatment of risk factors concerning cardiovascular mortality in secondary prevention: MIRVAS Study.
abstract: OBJECTIVE
  The aim was to determine whether secondary prevention involving the comprehensive and intensive treatment of cardiovascular risk factors reduces cardiovascular events and cardiovascular mortality at 3-year follow up.
  
  
  METHODS
  The study design comprised a randomized, controlled, open trial in a routine clinical practice setting. In total, 247 patients who presented with acute coronary syndrome or stroke were selected. They were randomized to comprehensive and intensive treatment of cardiovascular risk factors (n=121) or to follow-up based on usual care (n=126). The main study outcomes were the number of cardiovascular events and cardiovascular mortality at 3-year follow-up. The percentage of patients in whom each risk factor was successfully controlled was a secondary outcome.
  
  
  RESULTS
  Overall, 88.8% of patients assigned to the intensive treatment group had a low-density lipoprotein cholesterol level <100mg/dl compared with 56.4% of the usual-care group (relative risk [RR]=1.57; 95% confidence interval [CI], 1.28-1.93), and 75.7% of diabetics had a hemoglobin A(1c) <7% compared with 28.6% of the usual-care group (RR=2.65; 95% CI, 1.13-6.19). There were four deaths due to cardiovascular causes and 26 nonfatal events in the intensive treatment group versus 17 deaths and 54 nonfatal events in the usual-care group. The cumulative survival rate at 3 years was 97.4% in the intervention group and 85.5% in the control group (p=.003).
  
  
  CONCLUSIONS
  Secondary prevention involving comprehensive and intensive treatment of cardiovascular risk factors reduced both morbidity and mortality at 3-year follow up.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España. miguel.m.palanco@gmail.com
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Moreno-Palanco
authors.forename: Patricia
authors.initials: P
authors.lastname: Ibáñez-Sanz
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciria-de Pablo
authors.forename: Alberto
authors.initials: A
authors.lastname: Pizarro-Portillo
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Salvanés
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez-Fernández
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D003191:Comprehensive Health Care; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors