Posadas-Romero C

Language: Spanish
References: 10
Page: 167-170
PDF size: 54.29 Kb.

ABSTRACT

Coronary artery disease (CAD) is the major cause of death in most developed countries and in many developing countries like Mexico. Epidemiologic studies initiated in the middle of the last century found that hypercholesterolemia, hypertension, tobacco smoking, diabetes mellitus, and other conditions are important precursors of atherosclerosis. With this knowledge, prevention of CAD was started. Some countries implemented a population strategy aimed at improving health-oriented behavior, mainly nutrition, smoking, and physical exercise in the entire population. The favorable changes in risk factors and better medical treatment for CAD patients have resulted in decreased coronary mortality over the past three decades. Randomized trials of antihypertensive treatment have shown that reduction of blood pressure leads to a decreased incidence of stroke and coronary events. Similarly, large secondary and primary prevention clinical trials of statin therapy have conclusively demonstrated the benefit of cholesterol lowering in preventing coronary morbidity and mortality. Despite this large body of scientific evidence, surveys in different countries show that in the population at large and particularly, in patients with documented CAD, preventive medical therapies are underutilized and, as a consequence, many patients are not achieving the recommended goals. Measures that increase compliance by both clinicians and patients to regimens with proven benefits are urgently required.

REFERENCES

1. Gu K, Cowie CC, Harris MI: Diabetes and decline in heart disease mortality in US adults. JAMA 1999; 281: 1291-1297.

2. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC: Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000; 343: 16-22.

3. Hu FB. Stampfer MJ, Manson JE, Grodstein F, Colditz GA, Speizer FE, et al: Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women. N Engl J Med 2000; 343: 530-537.

4. Vanberkel TFM, Boersma H, Roos-Hesselink JW, Erdman RAM, Simoons ML: Impact of smoking cessation and smoking interventions in patients with coronary heart disease. Eur Heart J 1999; 20: 1773-1782.

5. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al: Blood pressure, stroke, and coronary heart disease. 2. Short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990; 335: 827-838.

6. Hansson L, Zanchetti A, Carruthers SG, Dahl BJ, Elmfeldt D, Julius S, et al: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomized trial. Lancet 1998; 351: 1755-1762.

7. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, BirKenhll WH, et al: Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757-764.

8. La Rosa JC, He J, Vupputuri S: Effect of statins on risk of coronary disease. JAMA 1999; 282: 2340-2346.

9. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Eur Heart J 2001; 22: 554-572.

10. Qureshi AI, Suri FK, Guterman LR, Hopkins LN: Ineffective secondary prevention in survivors of cardiovascular events in the US population. Arch Intern Med 2001; 161: 1621-1628.