[Effect of cardiovascular risk factors on long-term morbidity and mortality following acute myocardial infarction]. / Efecto de los factores de riesgo cardiovascular sobre la morbimortalidad a largo plazo después de un infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: Generally, cardiovascular risk factors are poorly controlled after myocardial infarction. The objective of this study was to determine the effect of these risk factors on long-term morbidity and mortality in patients experiencing a myocardial infarction. METHODS: In total, 655 acute myocardial infarction survivors recorded in the IBERICA database for the Spanish province of Albacete were followed up. Provincial healthcare center databases and the regional death registry were consulted, and semistructured interviews were carried out. Bivariate and multivariate descriptive and comparative statistical analyses were performed. RESULTS: The median follow-up period was 5.5 years. At the end of the study, 74% of patients had hypertension or hypercholesterolemia, 39% had diabetes, 36% were obese, 13% smoked, and 1% were alcoholics. Overall, 48% of patients experienced a cardiovascular event. Uncontrolled hypercholesterolemia was found to be a risk factor for angina (odds ratio [OR]=2.4, 95% confidence interval [CI], 1.1-5.1), and uncontrolled diabetes was a risk factor for reinfarction (OR=3.5, 95% CI, 1.6-7.6) and stroke (OR=10.6, 95% CI, 3.6-31.2), both of which occurred earlier in patients with uncontrolled diabetes. In total, 115 (18%) patients died, with more than 50% of deaths being due to cardiovascular causes. Uncontrolled hypertension and diabetes were the most important risk factors for both overall and early mortality, whereas controlled hypercholesterolemia appeared to be a protective factor. CONCLUSIONS: The prevalence of cardiovascular risk factors in patients who have experienced a myocardial infarction is very high. Control of these risk factors influences both cardiovascular events and long-term mortality.