title: Cardiovascular secondary prevention in high-risk patients: a randomized controlled trial sub-study.
abstract: BACKGROUND
  Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients.
  
  
  METHODS
  Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient's general practitioner for assessment.
  
  
  RESULTS
  The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI -1.7 to 26.2 %).
  
  
  CONCLUSIONS
  Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.
  
  
  BACKGROUND
  ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. stina.jakobsson@umu.se.
authors.forename: Stina
authors.initials: S
authors.lastname: Jakobsson
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. lotta.irewall@gmail.com.
authors.forename: Anna-Lotta
authors.initials: AL
authors.lastname: Irewall
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. fredrik@cordiem.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bjorklund
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. thomas.mooe@umu.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mooe
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D008297:Male; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000188:drug therapy / Q000451:nursing / Q000517:prevention & control*; D013689:Telephone
chemical_list: D000959:Antihypertensive Agents; D008078:Cholesterol, LDL