Risk factors and treatment strategies in coronary heart disease

This study investigated risk factors and treatments in patients with coronary heart disease (CHD). It was determined that risk factors like smoking, obesity, and high blood pressure are common. It was also found that while use of medications was common, especially at early stages, people with CHD were unlikely to participate in a disease management program.

Coronary heart disease is a leading cause of death worldwide. CHD may appear in the early stages as the ‘acute coronary syndrome’ (ACS). This includes heart attacks and chest pain at rest (unstable angina). In later stages CHD may appear as stable CHD, where blood vessels supplying the heart are narrowed or blocked, and an ACS event may have occurred in the past.

In the first few months after an ACS event, patients are at high risk for another. Some people also have a long-term risk of having another ACS event. The risk of this occurring may be reduced by medications and lifestyle changes (such as exercise, healthy diet, and stopping smoking). This is recommended by guidelines, but evidence suggests that these are not always followed.

10,661 adults from 18 countries in Asia, Europe, and the Middle East participated in this study between 2013 and 2014. 3867 participants had been hospitalized with for an ACS event and almost half of them (49.4%) had a second ACS event. 6794 patients had stable CHD. 

Participants with ACS were younger than those with stable CHD. They were also less likely to have chronic kidney disease, disease in the blood vessels in the arms and legs, heart failure, and to have had a stroke. 22.8% of participants with ACS were obese, compared with 24.3% of those with stable CHD. Patients with ACS were less likely to have a family history of CHD. However, they were more likely to smoke (27.2% vs. 12.2%), to have diabetes (58.4% vs. 48.8%), and to have high blood pressure (77.7% vs. 75.5%) than those with stable CHD.

Patients with ACS were more likely to be taking medications to reduce the risk of other ACS events than patients with stable CHD. Drugs that stop clots from forming in blood vessels were taken by 94.3% of patients with stable CHD, compared with 98% of those with ACS. Drugs to lower fat cells in the blood were taken by 94.7% of patients with stable CHD, compared to 97.5% of those with ACS. Medications to lower blood pressure were taken by 69.4% of participants with CHD, compared to 72.7% of those with ACS.

Only 16.8% of patients with a first ACS event, and 10.8% of those with a second ACS event attended cardiac rehabilitation programs which consist of exercise training, education, and psychological support. Also, only 11.7% of participants with stable CHD and 3.7% of those with ACS attended a disease management program or education program for CHD.

The study concluded that risk factors for CHD, like smoking, lack of exercise, obesity, diabetes, and high blood pressure, are common in people with ACS and stable CHD. Furthermore, while attendance at cardiac rehabilitation and disease management programs is low, use of recommended medication is common. However, people with stable CHD are less likely to use these medications compared to patients with ACS.

Certain data, which may have affected the results, was not available to the researchers. For example, participants may have been unable to use certain medications for medical reasons, but this information was not available. 

This study was funded my Merck, the manufacturer of some medications used to prevent ACS events.

Discuss with your physician strategies to prevent ACS events.