Secondary prevention programme of ischaemic heart disease in the elderly: A randomised clinical trial.

Background Elderly patients have been underrepresented in secondary cardiovascular prevention programmes. This study aimed to ascertain the effects of a secondary coronary disease prevention programme in these patients. Design Open randomised intervention study with parallel groups. Methods One hundred and twenty-seven patients aged ≥70 years with a recent acute coronary syndrome were randomised to a protocolised clinical intervention plus usual care (intervention group, n = 64) or to usual care alone (control group, n = 63). Patients were assessed at baseline and after 12 months. The main outcome was the percentage of patients with optimal risk factor control after 12 months of follow-up. Secondary outcomes included changes in Mediterranean diet adherence, quality of life and functionality. Mortality was evaluated three years after the end of the intervention. Results One hundred and six patients (83.4%) completed 12 months of follow-up (54 in the intervention group and 52 in the control group). At the end of intervention, 34.2% more patients in the intervention group had achieved optimal risk factor control with a number needed to treat of 3 (relative risk 2.18, 95% confidence interval 1.36 to 3.50). The intervention group improved adherence to the Mediterranean diet ( p = 0.013) and functionality assessed by the Short Physical Performance Battery ( p = 0.047). No differences between groups were found in quality of life (Short-Form 36 Health Survey) or mortality after three years (hazard ratio 1.19, 95% confidence interval 0.41 to 3.45). Conclusions A secondary coronary disease prevention programme in elderly patients with a recent acute coronary syndrome improved risk factor control, Mediterranean diet adherence and functionality.

A folate-rich diet is as effective as folic acid from supplements in decreasing plasma homocysteine concentrations.

Background & Aims: At least 500 mug of folic acid are required daily to treat hyperhomocysteinemia. To reach this amount by dietary changes alone may be difficult because food has a low folic acid content and bioavailability. No studies have compared the effects of similar amounts of additional folate derived from a combination of folate-rich and fortified foods or folic acid from supplements on plasma total homocysteine (tHcy) concentrations, which was the aim of this study. Methods: Twenty male patients with hyperhomocysteinemia and coronary artery disease were included in a randomized, crossover intervention trial. Patients were treated daily with a combination of foods containing approximately 500 mug of folate or with one 500 mug capsule of synthetic folic acid over two five-week periods separated by a five-week wash-out period. Results: Plasma folate increased markedly (p<0.001) and plasma tHcy decreased (p<0.001) with both therapies. Folate-rich foods decreased tHcy by 8.6% (95% CI: -15.9 to -1.2) and synthetic folic acid capsules by 8% (95% CI: -13.3 to -2.7). Conclusions: This study shows, for the first time in the literature, that a folate-rich diet is as effective as folic acid capsules in decreasing plasma tHcy concentrations and adds further support to the recommendation of those diets to prevent cardiovascular disease.

[Secondary Preventive Program of atherosclerosis in a university hospital. Results and predictors of clinical course]. / Programa de Prevención Secundaria de la Arteriosclerosis de un hospital universitario. Resultados y factores predictivos del curso clínico.

BACKGROUND AND OBJECTIVE: Lipid therapeutic goals are not achieved in a high percentage of patients with coronary artery disease (CAD). We describe in this paper the methodology and results of the Hospital Universitario de Bellvitge Atherosclerosis Secondary Preventive Program (PPSHB), which is aimed at preventing ischemic recurrences by controlling atherogenic factors. PATIENTS AND METHOD: From January 1992 to December 1996, 882 patients with acute CAD entered the PPSHB and were seen on at least 2 occasions at the Unidad de Lípidos y Arteriosclerosis during a mean period of 10.4 (3.8) months. In 753 patients data on clinical follow-up were available. Follow-up data were collected by telephone interview and review of medical records. RESULTS: During the follow-up period at the Unidad de Lípidos y Arteriosclerosis, 71.9% of patients achieved the therapeutic goals or their LDLc improved >= 15%. These results were seen in 83.6%, 78.7% and 83.6% of patients with regard to HDLc, triglycerides and HDLc/LDLc ratio, respectively, while the percentage of patients receiving lipid-lowering drugs increased from 28% to 69%. During a follow-up of 33.7 (15.9) months, death (all causes; mean survival time: 20 [13.4] months) occurred in 41 patients (5.4%). On the other hand, hospitalization for cardiovascular disease was required in 113 patients (15%) during a mean follow-up until the first admission of 18.4 (14.2) months. The main independent predictor of unfavourable clinical course was not to reach the HDLc/LDLc ratio goal (HDLc/LDLc >= 0.27 or an increase >= 15%; OR = 2.1; 95% CI, 1.1-4.03). CONCLUSIONS: A systematic secondary preventive strategy may help achieve an adequate control of dyslipidemia in most CAD patients. In these patients, achieving the HDLc/LDLc therapeutic goal is associated with a less than half risk of hospitalization for cardiovascular disease or death from any cause.

Programa de Prevención Secundaria de la Arteriosclerosisde un hospital universitario. Resultados y factorespredictivos del curso clínico / Secondary Preventive Program of atherosclerosis in a university hospital. Results and predictors of clinical course

FUNDAMENTO Y OBJETIVO: En un alto porcentaje de pacientes con enfermedad coronaria (EC) no se alcanzan los objetivos en el tratamiento de las dislipemias. Describimos la metodología y los resultados del Programa de Prevención Secundaria del Hospital Universitario de Bellvitge (PPSHB), cuyo principal objetivo es prevenir las recurrencias isquémicas mediante el control de los factores aterogénicos.PACIENTES Y MÉTODO: Desde enero de 1992 a diciembre de 1996, 882 pacientes con EC fueron incluidos en el PPSHB y fueron visitados en la Unidad de Lípidos y Arteriosclerosis en, al menos, dos ocasiones durante un período medio (DE) de 10,4 (3,8) meses. En 753 pacientes se obtuvieron los datos sobre su evolución clínica mediante un cuestionario telefónico y revisión de las historias clínicas.RESULTADOS: Durante el período de seguimiento en la Unidad de Lípidos y Arteriosclerosis el 71,9 por ciento de los pacientes alcanzaron los objetivos terapéuticos o mejoraron un 15 por ciento o más el colesterol unido a lipoproteínas de baja densidad (cLDL). Este resultado se observó en el 83,6 por ciento de los pacientes para el colesterol unido a lipoproteínas de alta densidad (cHDL), el 78,7 por ciento para los triglicéridos y el 83,6 por ciento para el cociente cHDL/cLDL. En este período, el porcentaje de pacientes en tratamiento con fármacos hipolipemiantes aumentó del 28 al 69 por ciento. Durante el período de seguimiento de 33,7 (15,9) meses fallecieron, por cualquier causa, 41 pacientes (5,4 por ciento) y el tiempo medio de supervivencia fue de 20 (13,4) meses. La hospitalización por enfermedad cardiovascular ocurrió en 113 pacientes (15 por ciento), con un tiempo medio de seguimiento hasta el primer ingreso de 18,4 (14,2) meses. El hecho de no alcanzar el objetivo terapéutico del cociente cHDL/cLDL (cHDL/cLDL igual o superior a 0,27 o un aumento del 15 por ciento o superior) fue el principal factor predictivo de un curso clínico desfavorable, con una odds ratio de 2,1 (intervalo de confianza del 95 por ciento, 1,1-4,03).CONCLUSIONES: Una estrategia sistemática de prevención secundaria de la arteriosclerosis puede contribuir a lograr un control adecuado de las dislipemias en la mayoría de los pacientes con EC. En estos pacientes, alcanzar el objetivo terapéutico del cHDL/cLDL se asocia a una disminución superior al 50 por ciento del riesgo de reingresar por enfermedad cardiovascular o de fallecer por cualquier causa. (AU)