Current Cardiology Reports

, Volume 13, Issue 4, pp 287–295 | Cite as

Optimal Medical Therapy, Lifestyle Intervention, and Secondary Prevention Strategies for Cardiovascular Event Reduction in Ischemic Heart Disease

Article

Abstract

Medical and lifestyle secondary prevention strategies are essential components for reducing cardiovascular risk, irrespective of whether revascularization is performed. In patients with coronary artery disease (CAD), recent clinical trials have further clarified the management of lipid optimization, renin-angiotensin-aldosterone system inhibition, antiplatelet therapy, and diabetes. Still, many questions remain with regard to optimal secondary prevention strategies in patients with CAD. Despite the significant reductions in cardiovascular morbidity and mortality with secondary prevention therapies demonstrated in clinical trials, long-term adherence to these interventions remains relatively low, with reasons being multifactorial. One promising method to improve compliance is the use of trained nurses/case managers to routinely follow medications, and provide both lifestyle and behavioral counseling. Implementation of this strategy led to significant improvements in medication compliance and risk factor optimization, although these results require confirmation in a randomized clinical study. Given that poor compliance has been associated with worsening cardiovascular outcomes, effective CAD management should include strategies for improving patient adherence to therapies that have proven benefits.

Keywords

Coronary artery disease Medical therapy Diabetes Dyslipidemia Antiplatelet therapy Ischemic heart disease Lifestyle intervention Secondary prevention Cardiovascular event reduction 

Clinical Trial and Registry Acronyms

ACCORD

Action to Control Cardiovascular Risk in Diabetes

ADVANCE

Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation

AIM-HIGH

Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes

ARBITER

Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol

ARBITER 6-HALTS

Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6–HDL and LDL Treatment Strategies

BARI 2D

Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes

CHARISMA

Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance

COURAGE

Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation

CURE

Clopidogrel in Unstable Angina to Prevent Recurrent Events

ILLUMINATE

Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events

ONTARGET

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

PLATO

Platelet Inhibition and Patient Outcomes

REACH

Reduction of Atherothrombosis for Continued Health

TNT

Treating to New Targets

TRITON-TIMI

Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction

TRANSCEND

Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease

VA-HIT

Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial.

Notes

Disclosure

Conflicts of interest: P. Joseph: none; K. Teo: has received a grant from and been a consultant for Boehringer Ingelheim.

References

Papers of particular interest, published recently, have been highlighted as: •Of importance

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Population Health Research InstituteHamilton Health Sciences-McMaster UniversityHamiltonCanada

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