Achievement of the Targets of Lifestyle, Risk Factors and Drug Therapy by Patients with Coronary Artery Diseases in Turkey
Objective: The aim of this study was determine the rate of achievement of lifestyle, risk factors and drug therapy targets recommended for the secondary prevention in coronary artery patients and of the effects such as age, gender and event type on the achievement of risk factor targets
Methods: This cross-sectional study enrolled 136 patients with coronary artery disease who had an acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention. The data related to the risk factors, lifestyle, and drug therapies were determined using questionnaires, anthropometric and laboratory measurements. Data analysis was conducted using descriptive statistics and the Pearson’s Chi-square test.
Results: Of the patients, 19.9% were smokers, 44.8% were inactive, 41.2% were obese, and 36.8% did not maintain a healthy diet. Furthermore, 44.1% had elevated total cholesterol, 78.7% had low-density lipoprotein cholesterol ≥70 mg/dL, 35.3% had blood pressure ≥140/90 mm/Hg, and 52.1% of patients previously diagnosed with diabetes had a glycated hemoglobin A1c ≥6.5%. Elderly patients had high low-density lipoprotein cholesterol and were physically inactive whereas younger patients had high smoking rates. Only 39.7 % used lipid-lowering medication.
Conclusion: Results of this study showed that the achievement rate of treatment targets recommended for secondary prevention in coronary artery patients was low. Age was a factor affecting control rate of smoking, physical activity and low-density lipoprotein cholesterol.
Turkish Statistical Institute(TUİK), Cause of death statistics, 2015. TUİK Bulletin, No: 21526, 24 March 2016. [Accessed 10 May 2016].Available from URL: http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21526. (in Turkish).
Onat A, Karakoyun S, Akbaş T, Karadeniz F, Karadeniz Y, Çakır H, et al. Turkish adult risk factor survey 2014: Overall mortality and coronary disease incidence in Turkey’s geographic region. Arch Turk Soc Cardiol 2015; 43: 326–32.(in Turkish).
Müller-nordhorn J, Binting S, Roll S, Willich SN. An update on regional variation in cardiovascular mortality within Europe. European Heart Journal 2008;29:1316-26.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. On behalf of the INTERHEART Study Onvestigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937-52.
Onat A, Dogan Y, Uyarel H, Ceyhan K, Uzunlar B, Yazıcı M, et al. Blood Blood pressure levels in Turkish adults: Initial trend to ımproved blood pressure control.. Türk Kardiyol Dern Arş 2002; 30:749-57.(in Turkish).
Global adult tobacco survey (GATS) Turkey 2012. Ankara 2014. [Accessed 8 February 2017] Available from URL: http://www.halksagligiens.hacettepe.edu.tr/english/GATS_english.pdf. [in Turkish].
Sanisoglu SY, Oktenli C, Hasimi A, Yokusoglu M, Ugurlu M. Prevalence of metabolic syndrome-related disorders in a large adult population in Turkey. BMC Public Health 2006;6:92.
Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80.
Clark AM, Hartling L,Vandermeer B, Mcalister A. Meta- analysis: Secondary prevention programs for patients with coronary artery disease. Annals of Internal Medicine 2005;14: 659-672.
Tokgözoğlu L, Kaya EB, Erol Ç, Ergene O. EUROASPIRE III: a comparison between Turkey and Europe. Arch Turk Soc Cardiol 2010;38:164-72.(in Turkish ).
Ketsova K, Wood D, De Bacquer D, De Backer G, Ryden D, Jennings C, et al. On behalf of the EUROASPİRE Investigators. EUROASPİRE IV: A European society of cardiology on the lifestyle, risk factors and therapeutic management of coronary patients from 24 European countries. European Journal of Preventive Cardiology 2016;23:636-48.
Lee WL, Abdullah KL, Bulgiba AM, Abidin IZ. Prevalence and predictors of patient adherence to health recommendations after acute coronary syndrome: data for targeted interventions? European Journal of Cardiovascular Nursing 2012;12:512-20.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z,Verschuren WMM, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33: 1635–1701.
Baysal A, Aksoy M, Besler T, Bozkurt N, Keçecioğlu S, Merdol TK, et al. Diet Handbook. Hatiboglu Publisher, 2007. (in Turkish).
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc 2003; 35: 1381-95.
Oztürk M. Determination of physical activity level and validity and reliability of International Physical Activity Questionnaire at University students (dissertation). Hacettepe University Health Science Institute. Ankara, 2005.(in Turkish).
Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC, van Staveren WA. Effect Size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation 2005;112:924-34.
Montero JMM, Ramirez RA, Durán MDM, Zarzosa CP, Abraira V. Cardiac rehabilitation in patients with myocardial infarction: a 10- year follow-up study. Rev Esp Cardiol 2005;58: 1181-87.
Soares-Miranda L, Siscovick DS, Psaty BM, Longstreth W.T.Jr, Mozaffarian D. Physical activity and risk of coronary heart disease and stroke in older adults. The Cardiovascular Health Study. Circulation 2016;133:147-55.
Lee IM, Sesso HD, Oguma Y, Paffenbarger RS. Relative intensity of physical activity and risk of coronary heart disease. Circulation 2003;107:1110-16.
Salamonson Y, Everett B, Davidson P, Andrew S. Magnitude of change in cardiac health-enhancing behaviours 6 months following an acute myocardial infarction. European Journal of Cardiovascular Nursing 2007;6: 66–71.
Turkey Cardiovascular Diseases Prevention and Control Program. (2015-2020). Ankara 2015. [Accessed 16 October 2018]. Available from URL:https://www.tkd.org.tr/TKDData/Uploads/files/Turkiye-kalp-ve-damar-hastaliklari-onleme-ve-kontrol-programi.pdf. (in Turkish).
Dagenais GR, Yi Q, Lonn E, Sleight P, Ostergren J, Yusuf S. On behalf of HOPE trial Investigators. Impact of cigarette smoking in high-risk patients participating in a clinical trial. A substudy from the Heart Outcomes Prevntion Evaluation (HOPE) trial. European Journal of Cardiovascular Prevention and Reahabilitation 2005;12: 75-81.
Kinjo K, Sato H, Sakata Y, Nakatani D, Mizuno H, Shimizu M, et al. Impact of smoking status on long-term mortality in patients with acute myocardial infarction. Circ J 2005; 69:7-12.
Murphy BM, Worcester MUC, Goble AJ, Mitchell F, Navaratnam H, Higgins RO, et al. Lifestyle and physiological risk factor profiles six weeks after an acute cardiac event: Are patients achieving recommended targets for secondary prevention?. Heart, Lung and Circulation 2011;20: 446-51.
Eisenberg MJ, Windle SB, Roy N, Old W, Grondin FR, Bata I, et al. EVITA Investigators. Varenicline for smoking cessation in hospitalized patients with acute coronary syndrome. Circulation 2016; 133:21-30.
Quist-Paulsen P, Gallefoss F. Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ 2003; 327:1254-57.
Leong J, Molassiotis A, Marsh H. Adherence to health recommendations after a cardiac rehabilitation programme in post-myocardial infarction patients: the role of health beliefs, locus of control and psychological status. Clinical Effectiveness in Nursing 2004;8:26-38.
Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009;37:1083-96.
Turkey Chronic Diseases and Risk Factors Prevalence Study. Ankara 2013. [Accessed 17 October 2018]. Available from URL:https://sbu.saglik.gov.tr/ekutuphane/kitaplar/khrfat.pdf. (in Turkish).
Gustafsson I, Hildebrandt P, Seibaek M, Melchior T, Torp-Pedersen C, Køber L, et al. The TRACE Study Group. Long-term prognosis of diabetic patients with myocardial infarction: relation to antidiabetic treatment regimen. European Heart Journal 2000;21:1937–43.
Lehto S, Pyörala K, Mıettınen H, Rönnemaa T, Palomakıj P, Tuomılehto J, et al. Myocardial infarct size and mortality in patients with non-insulin-dependent diabetes mellitus. J Intern Med 1994; 236: 291-7.
Patel A, MacMahon S, Chalmers J, Neal B, Billot L,Woodward M, et al. Intensive blood glucose control and vascular out-comes in patients with type 2 diabetes. N Engl J Med 2008; 358:2560–72.
Gerstein HC, Miller ME, Ismail-Beigi F, Largay J, McDonald C, Lochnan HA, et al. for the ACCORD Study Group. Effects of intensive glycaemic control on ischaemic heart disease: analysis of data from the randomised, controlled ACCORD trial. Lancet 2014; 384: 1936–41.
Turkey Diabetes Prevention and Control Program Action Plan. Ankara 2011.[Accessed 18 October 2018]. Available from URL:https://www.diabetcemiyeti.org/c/turkiye-diyabet-onleme-ve-kontrol-programi. (in Turkish).
McQueen MJ, Hawken S, Wang X, Ounpuu S, Sniderman A, Probstfield J, et al. for the INTERHEART study investigators. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet 2008;372: 224–33.
Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials. Lancet 2015; 385:1397–405.
Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 38: 957-67.
Newby LK, Allen LaPointe NM, Chen AY, Kramer JM, Hammill BG, DeLong ER, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation 2006; 113: 203-12.
Menezes AR, Lavie CJ, Forman DE, Arena R, Milani RV, Franklin BA. Cardiac rehabilitation in the elderly. Prog Cardiovasc Dis 2014;57:152-9.
Cooper AF, Jackson G, Weinman J, Horne R. Factors associated with cardiac rehabilitation attendance: a systematic review of the literature. Clin Rehabil 2002;16:541-52.
All opinions and reports within the articles that are published in the Gazi Medical Journal are the personal opinions of author(s). Gazi University, Editors and the publisher do not accept any responsibility for these articles.