Multifactorial lifestyle interventions aim ed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events .
Therefore , they may have added value in secondary prevention of CHD
CONTEXT Coronary heart disease ( CHD ) is responsible for about 15 % of all deaths worldwide and is identified as a top priority for decision makers .
Both primary and secondary prevention are considered key strategies in the prevention of CHD .
The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care .
[Cardiovascular morbimortality reduction after an acute cardiovascular event through multifactorial and intensive cardiovascular risk factors management (MIRVAS project)].
BACKGROUND AND OBJECTIVE In spite of publication of many guidelines , management of patients on secondary prevention of cardiovascular disease is still not appropriated . We design a r and omized trial , in usual clinical practice conditions , to compare the results in cardiovascular morbimortality of intensive and integral management of cardiovascular risk factors ( CVRF ) management versus conventional care . PATIENTS AND METHOD We selected patients discharged between October 2002 and January 2004 who suffered an acute coronary syndrome with or without ST-segment elevation or a stroke , 247 patients that met inclusion s criteria were r and omized to intensive care of CVRF  in a specific Internal Medicine outpatient clinic ( n = 121 ) or usual care according to National Health Service recommendations ( n = 126 ) . A year after r and omization , the percentage of patients who met CVRF control , treatment received and the number of cardiovascular events ( cardiovascular death , acute coronary syndrome with or without ST-segment elevation , stroke , transient ischemic attack , revascularization , lower limb amputation , heart failure admission and sudden death ) were revised . RESULTS CVRF control was greater in patients assigned to intensive care . 74.1 % of hypertensive patients assigned to this treatment were controlled vs 41.7 % in the usual care group ( relative risk [ RR ] = 1.78 ; 95 % confidence interval [ CI ] , 1.27 - 2 - 49 ) ; 70.2 % of patients had low-densi-tiy lipoprotein cholesterol lower than 100 mg/dl vs 55.8 % ( RR = 1.26 ; 95 % CI , 1.00 - 1.58 ) of patients in usual care group ; 93.1 % of diabetic patients had glycosylated haemoglobin lower than 7 % vs. 57.1 % ( RR = 1.63 ; 95 % CI , 1.11 - 2.39 ) in the usual care group . There were 12 cardiovascular events in the intensive care group vs 35 in the usual care group . CONCLUSIONS Intensive management of CVRF leads to a better control of them and a reduction of the morbimortality one year after an acute cardiovascular event
Multifactorial lifestyle interventions aim ed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events .
Therefore , they may have added value in secondary prevention of CHD
CONTEXT Coronary heart disease ( CHD ) is responsible for about 15 % of all deaths worldwide and is identified as a top priority for decision makers .
Both primary and secondary prevention are considered key strategies in the prevention of CHD .
The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care .