Determinants and risk factors for early risk stratification and optimal secondary pevention in ischemic heart disease

Abstract

Background: Ischemic heart disease is the leading cause of death globally. To combat ischemic heart disease and its challenges we must improve secondary prevention for those already affected and prevent its onset in a general population. Aim: To study risk factors for the incidence of ischemic heart disease and identify determinants of suboptimal secondary prevention. Methods: In Paper I, a prospective cohort of patients with a first myocardial infarction underwent a structured interview and examinations two years after their myocardial infarction. Papers II and III analyzed data from two cohorts of men from the general Swedish population, the “Study of Men Born In 1913” and the “Study of Men Born In 1943”, who had been followed longitudinally from 50 to 70 years of age. In Paper IV, patients with a first myocardial infarction in the Swedish National Inpatient Register were linked to the Prescribed Drug Register to examine the relationship between secondary preventive, pharmacological treatment, and mortality and/or recurrent myocardial infarction. Results: Secondary prevention two years after a myocardial infarction was suboptimal and multifactorial. The use of pharmacological treatment as secondary prevention decreased in the first years after an acute myocardial infarction and remained low during the follow-up of up to 16 years. The incidence of myocardial infarction has decreased over time among men in Sweden, and in parallel, the risk profile has changed. The addition of the biomarker hs‐TNT to risk factors, was able to enhance prediction of ischemic heart disease at an earlier stage in the general population. Conclusions: Secondary prevention including pharmacological treatment is vital to improve the prognosis in patients with ischemic heart disease, but it remains suboptimal. Despite the reduced incidence of myocardial infarction, it is still challenging to modify risk factors before the onset of an ischemic event. For a better risk stratification, early prediction and detection of ischemic heart disease is crucial.