Effect of secondary prevention on all-cause mortality in Czech survivors of myocardial infarction: A population-based study

Abstract

Background: In spite of successful introduction of interventional treatment of acute coronary syndromes in Czech Republic, recent surveys show that coronary intervention and drug therapies need to be combined with a lifestyle and risk factor intervention. We assessed the effect of intervention after myocardial infarction targeting multiple risk factors in a high-risk population with limited access to hypolipidemic drugs and revascularization. Methods: In 1992-1993, we enrolled all men under age 60 (n = 68) and all women under age 65 (n = 40) who survived myocardial infarction and were discharged from a single coronary care unit in an 18-month intervention program targeting dyslipidemia, smoking and highly saturated fats diet. Thirty % were diabetic and 46% of the remainder fulfilled ATP III criteria for the metabolic syndrome. Results: After one year, non-HDL cholesterol fell by 27%, smoking from 47% to 16%, and diet scores were substantially improved. As compared with a control population of 96 patients discharged from this CCU during the same period in 1990-1991, all-cause mortality in men was significantly reduced over 2.6 years (hazard ratio ranging from 0.083 to 0.18) and remained lower over 6.7 years of maximum follow-up. Among women, all-cause mortality was not significantly changed by the intervention. Conclusion: Multifactor intervention after myocardial infarction in men under age 60 with limited access to revascularization procedures dramatically reduced all-cause mortality for 2.6 years.