Clinical Profile of a Patient After Myocardial Infarction and Acute Cerebrovascular Accident Based on Outpatient Register Data
Conditions: Acute Cerebrovascular Accident, Myocardial Infarction (MI)
Sponsor: State Institution "Republican Scientific and Practical Center" Cardiology, Belarus

NCT07159698 
30.09.2025 
 
 
 
 
 
 
 
 
 
Clinical profile of a patient after myocardial 
infarction and acute cerebrovascular accident based on 
outpatient register data 
 
 
 
 
 
 
 
 
 
 
 
 
 
Republic of Belarus, Minsk, the Republican Scientific 
and Practical Center “Cardiology” 
2025 
 
 

Abstract 
The article presents the results of the analysis of outpatient register data of 
patients after myocardial infarction (MI) and acute cerebrovascular accident (ACVA). 
Based on the epidemiological characteristics of individuals included in the register, a 
clinical "portrait of a patient" after an acute cardiovascular event was formed. The 
features of clinical and laboratory parameters, as well as behavioral and metabolic 
factors of cardiovascular risk in patients included in the study were determined; and 
adherence to treatment before and after the reference event was assessed over a 12-
year follow-up period. 
The objective of the study: to determine the features of clinical and 
epidemiological characteristics and parameters of laboratory and instrumental studies, 
the profile of cardiovascular risk factors in patients with a history of MI and ACVA, 
and to establish their adherence to treatment before and after the reference event over 
a 12-year follow-up period. 
Materials and methods. We analyzed the data of 410 patients who applied to 
an outpatient and polyclinic healthcare organization between January 1, 2019, and 
December 31, 2022, with confirmed acute (recurrent) myocardial infarction and/or 
cerebral infarction that occurred between January 1, 2010, and December 31, 2019. 
Patients were included in the register after establishing their vital status as of January 
1, 2020. The data of records and reports from healthcare organizations (forms 025/u, 
131-u) and electronic outpatient records of medical information systems (MIS) from 
outpatient polyclinic institutions (OPI) were used. The results of the retrospective stage 
analysis of the study and the electronic patient database from the information and 
analytical system "Register of MI/ACVA" were presented. Standard methods of 
descriptive and analytical statistics, statistical software packages (SPSS, SAS, 
STATISTIKA 10, Stata) and programming languages (R, Python) were used. 
Results. Lipid metabolism disorders were identified in 36.8% (n=151) of the 
patients included in the register. It was noted that lipid-lowering therapy was prescribed 
to 21.7% (n=89) of the patients included in the study. The lowest rate of this therapy 
was found in the ACVA group – 7.9% (n=18). In patients who had both MI and ACVA 
(ACVA+MI group), it was 45% (n=9). Among MI patients (MI group), lipid-lowering 
therapy was prescribed in 38.5% (n=6) of cases. 
Target blood pressure (BP) levels were not achieved in 81.7% (n=335) of 
patients in all three study groups, which was confirmed by registration of elevated BP 
levels exceeding 139/89 mm Hg during medical examinations, most frequently 
observed in the ACVA group.  
The comorbid background, which allowed to classify the register patients as 
extremely high cardiovascular risk individuals, was characterized by type 2 diabetes 
mellitus (DM) in one-third of cases (n=127). 

The insufficient level of adherence to medical recommendations for modifying 
major cardiovascular risk factors was established: the percentage of individuals who 
reduced excess weight was 2.4% (n=10), quit smoking – 1.9% (n=8), achieved target 
lipid profile values – 3.4% (n=14), adjusted nutrition– 0.2% (n=1), and increased 
physical activity – 0.2% (n=1). However, notes regarding the issuance of 
recommendations were present in the medical records for most patients – in 95.6% 
(n=392) of cases. The highest level of adherence to recommended measures was 
observed concerning hypertension treatment – 88.5% (n=363). 
Conclusion. The features of clinical and epidemiological, and laboratory 
characteristics, as well as the prevalence of cardiovascular risk factors such as smoking, 
alcohol abuse, arterial hypertension, dyslipidemia, obesity, and diabetes mellitus, were 
established in patients with a history of myocardial infarction and acute 
cerebrovascular accident. The adherence of this category of patients to treatment was 
assessed over a 12-year period before and after the reference event. Based on the 
outpatient register data, a clinical "portrait of a patient" after myocardial infarction and 
acute cerebrovascular accident was formed. 
Key words: registers, myocardial infarction, acute cerebrovascular accident, 
quality of medical care, outpatient and polyclinic institutions. 
 
The establishment of an outpatient register of patients with a history of 
myocardial infarction (MI) and acute cerebrovascular accident (ACVA) of any 
remoteness has become the first step in systematizing clinical and epidemiological 
studies in cardiology in the Republic of Belarus. Its relevance is determined by the 
necessity to enhance the effectiveness of medical prevention of socially significant and 
clinically costly complications of cardiovascular diseases (CVD), as well as the search 
for ways to improve the quality of primary and specialized medical care for cardiac 
patients. The scientific component of this study is based on the analysis of data on 
patients with high cardiovascular risk accumulated using information and computer 
technologies and the application of the mathematical modeling methods to determine 
strategic directions of organizational activities in healthcare. The chosen direction of 
creating and using the results of the study of the outpatient register data of patients with 
a history of MI and ACVA of any remoteness is particularly relevant given that, in the 
Republic of Belarus, in 2019, at the time of publication of the latest official statistics, 
1,480 people died from MI, ten times more from ACVA - 13,232 patients. The 
incidence of recurrent ACVA was twice as high as that of recurrent myocardial 
infarction. The key organizational aspect in working with this category of patients is 
the comprehensive assessment of prognostically significant risk factors for the 
development of adverse outcomes and comorbidity indices in patients with a history of 
acute cardiovascular catastrophes, which allows the created outpatient register to be 
made. This function distinguishes the register favorably from other information 

technologies such as registries, databases, and randomized clinical trials, which are 
considered the "gold standard" of evidence-based medicine in the development of 
clinical guidelines.  
According to international registers, during the outpatient-polyclinic stage of 
medical care among patients with a history of MI and/or cerebral stroke (CS), in 65-
75% of cases, the time since the initial acute event at the moment of patient inclusion 
in the study was over one year, and in 55-65% of cases, it was over two years. The 
proportion of deaths among individuals who had both events was 20%. Non-fatal 
recurrent cardiovascular complications in individuals with a history of MI were 4%, 
while it was 2.4% for those with a history of CS. In patient after CS, acute myocardial 
infarction (AMI) developed in 1.2% of cases, and the incidence of recurrent CS in this 
group was 9.2%. In individuals with a history of MI and CS, recurrent CS occurred in 
8.2% of cases, while recurrent myocardial infarction occurred in 4.2%. The annual 
mortality rate in the MI group was 4.1%, in the CS group it was 8.2%, and in the 
MI+CS group it was 12.2% [1,2]. 
High morbidity and mortality rates from diseases of the circulatory system 
(DCS) represent an unresolved issue in modern healthcare [3]. In 2023, the primary 
incidence of DCS in the Republic of Belarus amounted to 342 thousand cases or 3,731 
cases per 100 thousand population [4]. According to the National Statistical 
Committee, in 2019, 120,470 people died in the Republic of Belarus from all causes, 
including 23,375 of working age, with 71,017 deaths attributed to DCS (59.0% of the 
total mortality structure). The cardiovascular mortality rate in Belarus in 2019 was 
754.1 per 100 thousand population [5]. Myocardial infarction and acute 
cerebrovascular accidents, which combines ischemic or cardioembolic cerebral 
infarction as well as hemorrhagic stroke [6,7], occupy leading positions in the causes 
of mortality and disability in the population. Half of the patients after ACVA have 
limitations in life activities [8], necessitating additional measures aimed at minimizing 
the negative impact of this complication on public health indicators. Prognostic data 
published in the scientific literature suggest an increase in mortality from DCS 
worldwide. This is attributed to an increase in average life expectancy, the proportion 
of elderly individuals in the population structure, and an increase in the prevalence of 
cardiovascular risk factors [9-11]. As a result, a twofold increase in expenditures for 
medical prevention, diagnosis, and treatment of CVD is expected, along with a 60% 
increase in indirect costs due to low labor productivity [12,13]. Since 2006, 
comprehensive measures have been implemented within demographic security 
programs in the Republic of Belarus aimed at creating conditions for improving public 
health, actively detecting diseases, timely treatment, and reducing mortality in the 
working-age population [14-16]. 
According to the World Health Organization, there has been a consistent 
increase in the total number of ACVA and related fatalities over the past 20 years [7]. 

Observations have revealed that mortality from ACVA exceeds that of MI [17]. The 
effective quality control of medical care, which facilitates rational allocation of 
available resources for secondary medical prevention of MI and ACVA [9], is possible 
through epidemiological studies [18]. 
The enhancement of effectiveness of medical monitoring for patient groups at 
high cardiovascular risk, as identified in the register, will contribute to the 
improvement of medical, demographic, and socioeconomic indicators in the country. 
The objective of the study is to determine the features of clinical and 
epidemiological characteristics and parameters of laboratory and instrumental studies, 
the profile of cardiovascular risk factors in patients with a history of MI and ACVA, 
and to establish their adherence to treatment before and after the reference event over 
a 12-year follow-up period. 
Materials and Methods 
The inclusion criteria: history of MI and/or ACVA of any remoteness; visit to the 
outpatient clinic for any reason during the period from January 1, 2019, to December 
31, 2022; age 18 years or older; the presence of informed consent for the processing of 
personal data in the outpatient medical record; and permanent residence in the city 
where the register is being established. 
The exclusion criteria: non-compliance with the inclusion criteria. 
The date of inclusion in the register corresponded to the date of the reference 
visit to the outpatient clinic (the initial visit during the inclusion period from January 
1, 2019 to December 31, 2022). The duration of the follow-up period was 24 months 
or more. The list of patients for inclusion in the register in accordance with the above 
criteria was compiled based on information from electronic databases regarding those 
who visited the outpatient clinic during the specified period. To ensure the objectivity 
of this list, the fact of visiting the outpatient clinic of patients with a history of MI 
and/or ACVA in the corresponding calendar year and previously included in the annual 
lists starting from 2010 was verified during the inclusion period. The data of records 
and reports from healthcare organizations (forms 025/u, 131-u), electronic outpatient 
records of the MIS OPI, electronic databases of patients included in the IAS "Register 
of MI/ACVA", and the results of the retrospective stage of the study were used. All 
information regarding patients included in the register was exported from their 
outpatient medical record and official electronic databases into the developed form 
"Patient card included in the register." This card fully presented the main demographic 
and anthropometric indicators (age, sex, education, height, weight, etc.), medical 
history data, primary disease risk factors, cardiovascular and comorbid conditions, 
baseline data on clinical examination and treatment conducted at the outpatient stage, 
information on visits to doctors in OPI, ambulance calls, and hospitalizations. The 
information regarding patients was retrieved from the database and exported in EXCEL 
format based on the following parameters: 

clinical and epidemiological (sex, age, education, presence or absence of 
disability group, hereditary history, past acute cardiovascular events, presence of 
comorbid pathology, and medical examination); 
clinical and laboratory (serum blood glucose levels, total cholesterol, high-
density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides (TG), blood 
pressure, BMI); 
presence of risk factors (smoking, alcohol abuse, physical inactivity, and 
unhealthy diet). 
Statistical software packages (SPSS, SAS, STATISTIKA 10, Stata) with 
standard methods of descriptive and analytical statistics, programming languages (R, 
Python), and mathematical modeling methods were used. Quantitative indicators were 
presented as arithmetic mean ± standard deviation (M ± σ). Qualitative variables were 
described with their absolute values and proportions expressed as n (%). 
At this stage of the study, the sex-age structure of patients, the prevalence of the 
main cardiovascular risk factors, clinical laboratory and instrumental research 
indicators, analysis of information on visits to a cardiologist and general practitioner, 
hospitalizations, ambulance calls, and medical examinations of patients included in the 
study were taken into account. 
Results and Discussion. 
1. General epidemiological characteristics of patients included in the 
register 
Data of 410 patients from two pilot outpatient clinics included in the register, 
who had one or more adverse acute cardiovascular events (ACVA, MI) registered in 
the period from 2010 to 2019, were analyzed. Among them, 229 (55.9%) patients had 
ACVA, 161 (39.3%) had MI, and 20 (4.9%) had both ACVA and MI. The register data 
enabled us to determine some social characteristics of the studied individuals (Table 
1). 
 
Table 1. – Educational background of patients in the study groups, (%) 
Education 
Total 
%, (n = 342) 
ACVA 
%, (n = 178) 
MI 
%, (n = 146) 
ACVA+MI 
%, (n = 18) 
Higher 
19,9 (68) 
14,0 (25) 
24,0 (35) 
44,4 (8) 
Secondary 
24,6 (84) 
29,2 (52) 
20,5 (30) 
11,1 (2) 
Vocational 
secondary 
53,2 (182) 
55,1 (98) 
52,1 (76) 
44,4 (8) 
Academic degree 
0,6 (2) 
0,6 (1) 
0,7 (1) 
0,0 (0) 
Incomplete 
vocational 
0,9 (3) 
1,1 (2) 
0,7 (1) 
0,0 (0) 
 

The indicators were calculated in all patient groups, except those marked as "no 
data" (n = 68). The highest incidence of adverse cardiovascular events was registered 
in patients with secondary and vocational secondary specialized education, at rates of 
24.6% and 53.2%, respectively. In patients with higher education, acute events 
occurred in 19.9% of cases. Myocardial infarction was most frequently observed in 
this category (24.0%), while acute cerebrovascular accidents were more prevalent in 
patients with secondary and vocational secondary specialized education (29.2% and 
55.1%, respectively, versus 14.0% in patients with higher education). Data on 
disability due to CVD were distributed as follows (Table 2). 
 
Table 2. – Prevalence of disability in the study groups, (%)  
Characteristic 
Total 
%, (n = 410) 
ACVA 
%, (n = 229) 
MI 
%, (n = 161) 
ACVA+MI  
%, (n = 20) 
Disability 
62,4 (256) 
66,4 (152) 
54, 0 (87) 
85,0 (17) 
No data 
0,5 (2) 
0,3 (1) 
1,2 (2) 
5,0 (1) 
 
In total, 256 individuals (62%) were disabled. The highest disability rate was 
observed in the ACVA+MI group – 85%, while the largest group of disabled 
individuals consisted of patients with a history of ACVA – 152 individuals (66.4%). 
People without an established disability group made up 38%. 
When analyzing the structure of ACVA in patients included in the register, a 
predominance of unspecified forms of this pathology was identified, indicating low 
statistical recording informativeness – 64.2% of individuals had no indication of the 
ACVA type in the medical documentation. Indicators were calculated for all study 
groups except cases marked as "no data" and "unspecified" (n = 150 and n = 3, 
respectively). The highest proportion of patients with ischemic MI (78.0%) was 
registered, significantly exceeding the number of individuals with hemorrhagic stroke 
(22.0%). When combined with myocardial infarction, ischemic stroke was more 
frequently registered – 85.7% (Table 3). 
 
 
 
Table 3. Structure of ACVA in the study groups, (%) 
Tupe of ACVA 
ACVA 
(n = 82) 
ACVA+MI 
(n = 14) 
Ischemic 
78,0 (64) 
85,7 (12) 
Hemorrhagic 
22 (18) 
14,3 (2) 
 
Among the patients included in the register, the incidence of acute MI in the MI 
and MI+ACVA groups was 83.9% and 95.0%, respectively. A recurrent coronary event 

was identified in a higher percentage of cases in patients with a history of MI—16.1%. 
In the ACVA group, a recurrent MI developed in one (5%) patient (Table 4). 
 
Table 4. – Distribution of patients in the study groups by type of previous MI, (%) 
Type of MI 
MI 
%, (n = 161) 
ACVA+MI 
%, (n = 20) 
Acute 
83,9 (135) 
95 (19) 
Recurrent 
16,1 (26) 
1 (5) 
 
2. Prevalence of the main cardiovascular risk factors, analysis of clinical, 
laboratory and instrumental study indicators. 
It was established that patients after ACVA were more likely to have a family 
history compared to the MI group (25.3% versus 19.9%). Adverse cardiovascular 
events occurred more often in men (55.6%) than in women in all study groups. The 
highest proportion of men was observed in both MI and ACVA groups – 64.0% and 
50.2%, respectively. In the ACVA+MI group, the number of men and women was 
equal: 10 individuals (50%) in each category. 
The average age of patients included in the study was 68.6 ± 10.7 years. Patients 
with a history of MI were predominantly men aged 64.1 ± 11.8 years, with a mean age 
of 63.3 ± 9.5 years. The average age of women in this group was 71.9 ± 11.2 years. 
Patients with a history of ACVA had an mean age of 66.9 ± 9.5 years (men: 65.64 ± 
10.69 years, women: 73.19 ± 5.63 years). The average age in the ACVA+MI group 
was 69.5 ± 10.0 years (Table 5, Figure 1). 
 
 
 
Table 5. – Characteristics of the main non-modifiable risk factors in the study groups 
Characteristic 
Total 
%, (n = 410) 
ACVA 
%, (n = 229) 
MI  
%, (n = 161) 
ACVA+ 
MI %, 
(n = 20) 
Women 
44,5 (182) 
49,8 (114) 
36,0 (58) 
50,0 (10) 
Men 
55,6 (228) 
50,2 (115) 
64,0 (103) 
50,0 (10) 
Age, years 
68,59 ± 10,7 
66,9 ± 9,5 
63,3 ± 9,5 
69,5 ± 10,0 
Family History  
22,7 (93) 
25,3 (58) 
19,9 (32) 
15,0 (3) 
 
 

 
Figure 1. Age distribution of patients in the study groups. 
 
The highest incidence of ACVA was identified in the 71–75 age group, while 
MI was most prevalent in the 61–65 age group. At the same time, there was an increase 
in the number of adverse cardiovascular events in both groups starting at age 51. After 
age 65, there was a decrease in MI cases and an increase in ACVA cases. 
Table 6 contains data on the frequency of modifiable risk factors for CVD in the 
three study groups.  
 
Table 6. – Frequency of the main modifiable risk factors in the study groups, (%) 
Indicator 
Total 
%, (n = 410) 
ACVA 
%, (n = 229) 
MI 
%, (n = 161) 
ACVA+MI 
%, (n = 20) 
Smoker 
7,6 (31) 
5,2 (12) 
11,8 (19) 
0,0 (0) 
Non-smoker 
89,7 (368) 
91,3 (209) 
86,9 (140) 
95,0 (19) 
No smoking data 
2,7 (11) 
3,5 (8) 
1,2 (2) 
5,0 (1) 
Alcohol abuse 
5,4 (22) 
1,3 (3) 
10,6 (17) 
10,0 (2) 
Hypodynamia 
0,2 (1) 
0,4 (1) 
0,0 (0) 
0,0 (0) 
Unhealthy diet 
1,0 (4) 
0,0 (0) 
2,5 (4) 
0,0 (0) 
Presence 
of 
obesity 
24,1 (99) 
23,1 (53) 
25,5 (41) 
25,0 (5) 
Class I obesity 
11,5 (47) 
10,5 (24) 
13,0 (21) 
10,0 (2) 

Class II obesity 
4,4 (18) 
4,4 (10) 
4,3 (7) 
5,0 (1) 
Class III obesity 
3,4 (14) 
3,1 (7) 
3,1 (5) 
10,0 (2) 
Unspecified 
obesity  
4,9 (20) 
5,2 (12) 
4,9 (8) 
0,0 (0) 
No obesity 
75,8 (311) 
76,8 (176) 
74,5 (120) 
75,0 (15) 
Dyslipidemia 
36,8 (151) 
38,0 (87) 
34,2 (55) 
45,0 (9) 
Presence 
of 
hypertension 
97,3 (399) 
98,7 (226) 
95,0 (153) 
100,0 (20) 
Stage 
I 
hypertension 
9,5 (39) 
6,1 (14) 
14,3 (23) 
10,0 (2) 
Stage 
II 
hypertension 
72,0 (295) 
71,6 (164) 
72,7 (117) 
70,0 (14) 
Stage 
III 
hypertension 
15,9 (65) 
20,5 (47) 
8,7 (14) 
20,0 (4) 
No 
data 
on 
hypertension 
1,2 (5) 
0,9 (2) 
1,9 (3) 
0,0 (0) 
Episodes 
of 
increased 
BP 
above 139/89 mm 
Hg 
81,7 (335) 
88,6 (203) 
72,7 (117) 
75,0 (15) 
Presence of DM 
30,9 (127) 
29,3 (67) 
32,3 (52) 
40,0 (8) 
DM2 
30,2 (124) 
27,9 (64) 
32,3 (52) 
40,0 (8) 
DM1 
0,2 (1) 
0,4 (1) 
0,0 (0) 
0,0 (0) 
Unspecified DM 
0,5 (2) 
0,9 (2) 
0,0 (0) 
0,0 (0) 
 
It was found that 89.7% (n=368) of the participants in the study groups were 
non-smokers. Furthermore, most of the non-smokers were identified in the group of 
patients with a history of ACVA – 91.3% (n=208). Among individuals with a history 
of MI, this indicator was 86.9% (n=140). Alcohol abuse was most frequently noted in 
the MI group – 10.6% (n=17) versus 1.3% (n=3) among patients after ACVA. No 
smokers were registered in the ACVA+MI group, and alcohol abuse was noted in 2 out 
of 20 patients (10%) in this group. 
It was revealed that every fourth patient included in the register was overweight: 
class I obesity was more prevalent (11.5%, n=47), while a higher percentage of class 
III obesity was observed in the ACVA+MI group (10%, n=2). 
The BMI in the study groups was 28.5 ± 4.5 kg/m²: 28.4 ± 5.0 kg/m² in the 
ACVA group, 29.2 ± 4.8 kg/m² in the MI group, and 31.6 ± 6.1 kg/m² in the ACVA+MI 
group. A quarter of the patients (n=99) included in the register had varying degrees of 
obesity, with the highest proportion in the MI+ACVA group (25.0%, n=5) and the MI 

group (25.5%, n=41). Figure 2 shows the frequency of various BMI indicators in the 
study groups. 
 
 
a) All patients 
 
b) ACVA patients 
 
c) MI patients 
 
d) ACVA+MI patients 
Figure 2. Frequency of various BMI indicators in the study groups. 
 
Overweight (BMI 25.0–30.0 kg/m²) was most frequently identified among 
patients included in the outpatient register: 40.3% (n=77) in the ACVA group, 38.5% 
(n=42) in the MI group, and 25.0% (n=3) in the ACVA+MI group. 
An analysis of elevated total cholesterol levels over the past 12 months was 
conducted in the study groups (Figure 3). 

 
Figure 3. Dynamics of total cholesterol levels over the past 12 months in the study 
groups. 
 
The maximum levels of total cholesterol in the study groups throughout the 
follow-up period in the OPI and over the last 12 months were 5.8 ± 1.5 mmol/L and 
5.1 ± 1.4 mmol/L, respectively, 6.2 ± 1.4 and 5.2 ± 1.3 mmol/L in the ACVA group, 
respectively, 4.9 ± 1.3 and 5.0 ± 1.4 mmol/L in the MI group, respectively, and 5.8 ± 
1.8 mmol/L and 5.5 ± 1.6 mmol/L in the ACVA+MI group, respectively. An 
unacceptably high level of this indicator was observed in all study groups, which did 
not correspond to the recommended target values for secondary prevention. 
Comparison of lipid profile indicators over the last 12 months relative to maximum 
values is presented in Figure 4. 
 
 
a) Maximum LDL level and its dynamics 
over the past 12 months 
 
 
b) Maximum Tg level and its dynamics 
over the past 12 months 
 

 
c) HDL level in the study groups over the past 12 months 
 
Figure 4. Lipid profile indicators in the study groups. 
 
The maximum LDL level at the time of inclusion in the register and over the last 
12 months in the study groups was 3.3 ± 1.2 mmol/L (n = 240) and 3.1 ± 1.1 mmol/L 
(n = 180), respectively, 3.6 ± 1.2 mmol/L (n = 152) and 3.2 ± 1.1 mmol/L (n = 108) in 
the ACVA group, respectively, 2.8 ± 1.0 mmol/L (n = 77) and 3.0 ± 1.1 mmol/L (n = 
61) in the MI group, respectively, and 3.6 ± 1.5 mmol/L (n = 11) and 3.6 ± 1.3 mmol/L 
(n = 11) in the ACVA+MI group, respectively. The presented data indicate insufficient 
diagnostics for lipid metabolism disorders in patients included in the outpatient register 
and unsatisfactory achievement of target LDL levels. 
The maximum TG level at the time of inclusion in the register and over the last 
12 months in the study groups was 1.8 ± 1.0 mmol/L (n = 288) and 1.5 ± 0.7 mmol/L 
(n = 229), respectively, 1.8 ± 0.9 mmol/L (n = 193) and 1.5 ± 0.8 mmol/L (n = 156) in 
the ACVA group, respectively, 1.8 ± 1.2 mmol/L (n = 85) and 1.5 ± 0.7 mmol/L (n = 
61) in the MI group, respectively, and 1.9 ± 1.1 mmol/L (n = 10) and 1.6 ± 0.6 mmol/L 
(n = 12) in the ACVA+MI group, respectively. A positive dynamic of decrease in this 
indicator was observed in all groups. However, there was an insufficient number of 
patients in whom TG levels were determined (n = 288). 
The HDL level over the last 12 months in the study groups was 1.4 ± 0.4 mmol/L 
(n = 165), 1.3 ± 0.4 mmol/L (n = 100) in the ACVA group, 1.4 ± 0.4 mmol/L (n = 52) 
in the MI group, and 1.3 ± 0.3 mmol/L (n = 13) in the ACVA+MI group. There was an 
insufficient number of patients in whom HDL levels were determined (165 patients out 
of 410). 
 
The frequency of different ranges of maximum total cholesterol levels is 
presented in Figure 5. 

a) All patients 
b) ACVA patients 
c) MI patients 
d) ACVA+MI patients 
Figure 5. Frequency of different ranges of maximum total cholesterol levels in the 
study groups.  
 
Total cholesterol levels in the range of 4.0–6.0 mmol/L were found in 42% (n = 
89) of the ACVA group and 58% (n = 56) of the MI group. 
Figure 6 shows the frequency of different ranges of maximum LDL levels in the 
study groups. 
  

a) All patients 
b) ACVA patients 
c) MI patients 
d) ACVA+MI patients 
Figure 6. Frequency of different ranges of maximum LDL cholesterol levels in 
the study groups. 
 
The most frequently observed LDL level in the ACVA group was 3.0 – 4.0 
mmol/L; 38% (n = 58) of individuals had LDL levels in this range. In the MI group, 
this level was 2.0 – 3.0 mmol/L (48% (n=37) of those examined). 
An insufficient rate of prescribing lipid-lowering therapy was noted in all study 
groups – 21.7% of patients (n=89): the lowest rate was in the ACVA group (7.9%, 
n=18). In the MI group, correction was performed in 38.5% of cases (n=62).  
The incidence of hypertension was 97.3% (n=399) across all study groups. Stage 
II hypertension was the most frequently registered. Unsatisfactory achievement of 
target blood pressure was established in all three study groups, as evidenced by BP 
recording above 139/89 mmHg in 81.7% of cases (n=355), most frequently observed 
in ACVA patients (88.6%, n=203). 
Analyzing the comorbid background related to risk factors, it was noted that 
DM2 was recorded in one-third of cases (n=124), while DM1 was recorded in a few 
cases (n=1) in patients included in the study.  

In the ACVA group (n=63), the maximum glucose level was 10.5 ± 4.5 mmol/L. 
Over the past 12 months, glycemic levels were determined in only 2 patients (6.0 
mmol/L and 7.0 mmol/L). 
In the MI group (n=50), the maximum glucose level was 10.4 ± 4.5 mmol/L. 
Over the past 12 months, glycemic levels were determined in only 1 patient, who had 
a level of 6.0 mmol/L. 
In the ACVA+MI group (n=8), the maximum glucose level was 9.7 ± 2.6 
mmol/L. Over the past 12 months, glycemic levels were not determined in this patient 
group. 
The frequency of different ranges of maximum glucose levels in the study groups 
is shown in Figure 7. 
 
 
a) All patients 
b) ACVA patients 
 
c) MI patients 
 
d) ACVA+MI patients 
 
Figure 7. Frequency of different ranges of maximum glucose levels in the study 
groups. 
 
Two-thirds of the examined patients (73%, n = 250) had elevated blood glucose 
levels in the range of 5.0–10.0 mmol/L. This level of glycemia was established in 75% 

(n = 164) of the ACVA group, 72% (n = 78) of the MI group, and 67% (n=8) of the 
ACVA+MI group. 
There was a low level of adherence to medical recommendations for modifying 
the main cardiovascular risk factors: the percentage of individuals who reduced excess 
weight was 2.4% (n=10), quit smoking – 1.9% (n=8), achieved target lipid profile 
values – 3.4% (n=14), adjusted their diet – 0.2% (n=1), and increased physical activity 
– 0.2% (n=1). The highest level of adherence to the recommended measures was 
observed in treatment of arterial hypertension – 88.5% (n=363). It cannot be ruled out 
that the recommendations for modifying risk factors were communicated verbally. 
Records of issuing recommendations were present in the medical documentation of the 
majority of patients – 95.6% (n=392) (Table 7). 
 
Table 7 – Presence of recommendations for correction of the main modifiable risk 
factors and marks on their implementation in the study groups, (%) 
Risk Factor 
Total %, 
(n = 410) 
ACVA %, 
(n = 229) 
MI %, 
(n = 161) 
ACVA+MI 
%, (n = 20) 
Recommendations for risk factor correction 
Hypertension 
88,5 (363) 
95,6 (219) 
81,4 (131) 
65,0 (13) 
Overweight 
2,4 (10) 
0,0 (0) 
5,6 (9) 
5,0 (1) 
Smoking 
1,9 (8) 
0,9 (2) 
6 
0,0 (0) 
Hyperlipidemia 
3,4 (14) 
0,0 (0) 
5,6 (9) 
25,0 (5) 
Diet 
0,2 (1) 
0,0 (0) 
0,0 (0) 
5,0 (1) 
Hypodynamia 
0,2 (1) 
0,0 (0) 
0,6 (1) 
0,0 (0) 
None 
3,2 (13) 
3,5 (8) 
3,1 (5) 
0,0 (0) 
Completed mark 
Marked 
95,6 (392) 
96,1 (220) 
94,4 (152) 
100,0 (20) 
 
3.3 Assessment of patient adherence to treatment before and after the 
reference event over a 12-year follow-up period 
Table 8 shows the frequency with which patients in the study groups visited a 
specialist (therapist, cardiologist, neurologist) by patients in the study groups, as well 
as the number of ambulance calls to patients' homes. 
 
Table 8 – Rates of medical assistance seeking among patients included in the register, 
(%) 
Indicator 
Total %, 
(n = 410) 
ACVA %, 
(n = 229) 
MI 
%, (n = 161) 
ACVA+MI 
%, (n = 20) 

Visiting a general 
practitioner  
97,1 (398) 
100,0 (229) 
93,8 (151) 
90,0 (18) 
Visiting a 
cardiologist 
13,4 (55) 
3,1 (7) 
23,6 (38) 
50,0 (10) 
Visiting a 
neurologist 
83,2 (341) 
96,5 (221) 
65,8 (106) 
70,0 (14) 
Home visit by a 
doctor 
78,8 (323) 
92,1 (211) 
62,7 (101) 
55,0 (11) 
Calling an 
ambulance 
69,5 (285) 
79,5 (182) 
56,5 (91) 
60,0 (12) 
Hospitalization 
for treatment 
87,1 (357) 
55,3 (227) 
73,3 (118) 
60,0 (12) 
 
Analysis of the register data indicates a high level of patients consulting with 
therapists and an insufficient level of consultations with cardiologists. The highest 
frequency of ambulance calls was found in the ACVA group. The MI group had the 
highest percentage of hospitalizations, which requires attention from outpatient 
specialists. Table 9 shows data on the medical examination of patients included in the 
register. 
 
Table 9. – Indicators of medical examination of patients included in the register 
 
It was found that 95.6% and 98.1% of patients in the ACVA and MI groups, 
respectively, were under observation for their primary nosology. The created 
outpatient register enables analysis of medical examination effectiveness, assessment 
of cardiovascular risk factors prevalence, and determination of target indicator 
achievement frequency through modification.  
Conclusion. The main clinical and epidemiological characteristics and risk 
factors were established in patients with a history of myocardial infarction and acute 
cerebrovascular accident. Laboratory and instrumental study results were analyzed, 
Reason for 
medical 
examination 
Total %, 
(n = 410) 
ACVA 
 %, (n = 229) 
MI 
 %, (n = 161) 
ACVA+MI 
 %, (n = 20) 
CVD 
44,9 (184) 
3,9 (9) 
98,1 (158) 
85,0 (17) 
ACVA 
54,4 (223) 
95,6 (219) 
0,6 (1) 
15,0 (3) 
Not observed 
0,7 (3) 
0,4 (1) 
1,2 (2) 
0,0 (0) 

and treatment adherence before and after the reference event was assessed over a 12-
year follow-up period. A “portrait of a patient” with a history of an acute 
cardiovascular event was created: this is a male aged 67.7 ± 11.4 years (for patients 
with myocardial infarction) or 68.56 ± 10.9 (for patients with ACVA) with stage 1 
obesity, holding secondary or vocational secondary education, having a disability 
group, who does not smoke and does not abuse alcohol. The required target levels of 
BP, lipid profile, and glycemia were not achieved. 
Lipid metabolism disorders were identified in 36.8% of the patients included in 
the study. These changes were most frequently recorded in the MI+ACVA group (45%) 
and the ACVA group (38.0%). An insufficient level of lipid-lowering therapy 
prescription was established in all study groups: 21.7% of cases, the lowest of which 
was among patients with ACVA (7.9%). In the MI group, corrections were made in 
38.5% of cases. 
Failure to achieve target blood pressure levels in all study groups was evidenced 
by elevated levels above 139/89 mm Hg in 81.7% of cases, most frequently observed 
among patients with ACVA. 
The insufficient level of adherence to medical recommendations for modifying 
major cardiovascular risk factors was established: the percentage of individuals who 
reduced excess weight was 2.4% (n=10), quit smoking – 1.9% (n=8), achieved target 
lipid profile values – 3.4% (n=14), adjusted nutrition– 0.2% (n=1), and increased 
physical activity – 0.2% (n=1). The highest level of adherence to recommended 
measures was observed concerning hypertension treatment – 88.5% (n=363). 
The presented data demonstrate that creating registers is an important step 
towards the objective assessment of medical and demographic indicators and the 
development of scientifically based preventive measures at different levels of 
healthcare provision for cardiac patients. Registers are tools that enable the prediction 
of potential damage to public health caused by diseases of the circulatory system. 
Identifying the prevalence of modifiable cardiovascular risk factors will allow 
developing targeted preventive measures to reduce mortality and morbidity rates from 
diseases of the circulatory system, as well as creating precision rehabilitation programs 
that can be adapted to each patient's individual needs and living conditions. 
The authors declare no conflict of interest. 
 
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