title: Unfavourable risk factor control after coronary events in routine clinical practice.
abstract: Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event.
  
  
  
  A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up.
  
  
  
  Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed.
  
  
  
  The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits.
  
  
  
  Registered at ClinicalTrials.gov (ID NCT02309255 ).
authors.affiliation: Department of Medicine, Drammen Hospital, 3004, Drammen, Norway. elisbj@vestreviken.no.
authors.forename: Elise
authors.identifier: 0000-0002-1519-9759
authors.initials: E
authors.lastname: Sverre
authors.affiliation: Department of Medicine, Vestfold Hospital, Tonsberg, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Peersen
authors.affiliation: Department of Medicine, Drammen Hospital, 3004, Drammen, Norway.
authors.forename: Einar
authors.initials: E
authors.lastname: Husebye
authors.affiliation: Department of Medicine, Drammen Hospital, 3004, Drammen, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Gjertsen
authors.affiliation: Department of Cardiology, Oslo University Hospital Rikshospitalet, Medical Faculty, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.affiliation: Department of Medicine, Vestfold Hospital, Tonsberg, Norway.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Otterstad
authors.affiliation: Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway.
authors.forename: Toril
authors.initials: T
authors.lastname: Dammen
authors.affiliation: Department of Medicine, Drammen Hospital, 3004, Drammen, Norway.
authors.forename: John
authors.initials: J
authors.lastname: Munkhaugen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D009204:Myocardial Revascularization; D009664:Norway / Q000453:epidemiology; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult
keywords: Coronary heart disease; Guidelines; Risk factors; Secondary prevention