Ineffective Secondary Prevention in Survivors of Cardiovascular Events in the US Population: A Report from the Third National Health and Nutrition Examination Survey.
Background and Purpose: Survivors of myocardial infarction (MI) or stroke are at high risk for subsequent cardiovascular events. There is limited assessment of the effectiveness of risk factor modification through current secondary preventive strategies in the US population. Methods: The adequacy of control for hypertension, diabetes mellitus, cigarette smoking, alcohol use and hypercholesterolemia was assessed by personal interview, blood pressure measurements, and serum glycosylated hemoglobin and cholesterol levels in a nationally representative sample of US adults. We also evaluated the role of potentially related factors including age, gender, race/ethnicity, educational attainment, socioeconomic and medical insurance status using multivariate logistic regression analysis. Results: A total of 1252 survivors of MI or stroke were evaluated in the Third National Health and Nutrition Examination Survey. Among the 738 known hypertensive persons, hypertension was uncontrolled (systemic blood pressure >140/90 mm Hg) in 388 (53%) patients. Previously undiagnosed hypertension (systemic blood pressure > 140/90 mm Hg) was detected in 138 (11%)other survivors. Of the 1252 survivors, 225 (18%) persons were currently smoking and heavy alcohol use was observed in 56 persons. Hypercholesterolemia was poorly controlled (serum cholesterol >240mg/dl) in 185 (46%)of the 405 persons with known hypercholesterolemia. Undetected hypercholesterolemia was observed in 160 (13%) persons. In the multivariate analysis, high risk profiles (defined as presence of two or more poorly controlled risk factors) were more likely to be observed in persons aged 45–65 years (OR 2.5, 95% CI 1.3–4.8), women (OR 1.6, 95% CI 1.3–2.1) and African-Americans (OR 1.4, 95% CI 1.01–1.9). Conclusions: Our report points out the alarming magnitude of inadequate secondary prevention in the US population. Considerable efforts are required to effectively implement risk factor modification strategies after MI or stroke, particularly in middle aged persons, African-Americans and women.