open access

Vol 76, No 12 (2018)
REVIEWS
Published online: 2018-09-24
Submitted: 2018-09-24
Accepted: 2018-09-24
Get Citation

Secondary prevention of cardiovascular diseases: current state of the art

Gerd Hasenfuß
DOI: 10.5603/KP.a2018.0198
·
Pubmed: 30338502
·
Kardiol Pol 2018;76(12):1671-1679.

open access

Vol 76, No 12 (2018)
REVIEWS
Published online: 2018-09-24
Submitted: 2018-09-24
Accepted: 2018-09-24

Abstract

Prevention strategies for cardiac events depend of the risk for such an event. A very high risk is defined as a risk > 10% over 10 years. For example, a patient with known coronary artery disease has such a very high risk of death. However, a patient with diabetes and severe hypertension without known coronary artery disease carries the same risk. Here, secondary preven­tion and primary prevention overlap. Prevention guidelines include a number of general recommendations, such as changes in behaviour, nutrition, body weight, and physical activity as well as smoking intervention strategies. Drug treatment-based prevention strategies address diabetes mellitus, hypercholesterolaemia, platelet aggregation, and arterial hypertension. Follow­ing hospitalisation for heart failure or acute coronary syndrome, participation in a centre-based or home-based rehabilitation programme is recommended. There are a number of new treatment options with a promising potential to reduce the rate of events in patients with cardiovascular diseases and in patients with cardiovascular risk factors. Very recent treatment strategies include the PCSK9 inhibitors for hypercholesterolaemia and the SGLT2 inhibitors for reduction of cardiovascular events in patients with diabetes mellitus and increased cardiovascular risk.

Abstract

Prevention strategies for cardiac events depend of the risk for such an event. A very high risk is defined as a risk > 10% over 10 years. For example, a patient with known coronary artery disease has such a very high risk of death. However, a patient with diabetes and severe hypertension without known coronary artery disease carries the same risk. Here, secondary preven­tion and primary prevention overlap. Prevention guidelines include a number of general recommendations, such as changes in behaviour, nutrition, body weight, and physical activity as well as smoking intervention strategies. Drug treatment-based prevention strategies address diabetes mellitus, hypercholesterolaemia, platelet aggregation, and arterial hypertension. Follow­ing hospitalisation for heart failure or acute coronary syndrome, participation in a centre-based or home-based rehabilitation programme is recommended. There are a number of new treatment options with a promising potential to reduce the rate of events in patients with cardiovascular diseases and in patients with cardiovascular risk factors. Very recent treatment strategies include the PCSK9 inhibitors for hypercholesterolaemia and the SGLT2 inhibitors for reduction of cardiovascular events in patients with diabetes mellitus and increased cardiovascular risk.

Get Citation

Keywords

prevention, cardiovascular disease, intervention, treatment

About this article
Title

Secondary prevention of cardiovascular diseases: current state of the art

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 12 (2018)

Pages

1671-1679

Published online

2018-09-24

DOI

10.5603/KP.a2018.0198

Pubmed

30338502

Bibliographic record

Kardiol Pol 2018;76(12):1671-1679.

Keywords

prevention
cardiovascular disease
intervention
treatment

Authors

Gerd Hasenfuß

References (76)
  1. Piepoli M, Hoes A, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice.The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016; 37(29): 2315–2381.
  2. Podolec P, Jankowski P, Zdrojewski T, et al. Polish Forum for Prevention Guidelines on Cardiovascular Risk Assessment: update 2016. Kardiol Pol. 2017; 75(1): 84–86.
  3. Smeeth L, Thomas S, Hall A, et al. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004; 351(25): 2611–2618.
  4. Siriwardena AN, Gwini SM, Coupland CAC. Influenza vaccination, pneumococcal vaccination and risk of acute myocardial infarction: matched case-control study. CMAJ. 2010; 182(15): 1617–1623.
  5. Gwini SM, Coupland CAC, Siriwardena AN. The effect of influenza vaccination on risk of acute myocardial infarction: self-controlled case-series study. Vaccine. 2011; 29(6): 1145–1149.
  6. Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA. 2013; 310(16): 1711–1720.
  7. Rubak S, Sandbaek A, Lauritzen T, et al. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005; 55(513): 305–312.
  8. Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010; 122(4): 406–441.
  9. Balady GJ, Williams MA, Ades PA, et al. American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology, American Heart Association Council on Cardiovascular Nursing, American Heart Association Council on Epidemiology and Prevention, American Heart Association Council on Nutrition, Physical Activity, and Metabolism, American Association of Cardiovascular and Pulmonary Rehabilitation. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007; 115(20): 2675–2682.
  10. Piepoli MF, Corrà U, Benzer W, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010; 17(1): 1–17.
  11. Cahill K, Stevens S, Perera R, et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013(5): CD009329.
  12. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007; 1(CD000031).
  13. Cahill K, Stead LF, Lancaster T, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012(4): CD006103.
  14. Hughes J, Stead L, Hartmann-Boyce J, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2014; 1(CD00003).
  15. Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004; 328(7455): 1519.
  16. Kiiskinen U, Vartiainen E, Puska P, et al. Long-term cost and life-expectancy consequences of hypertension. J Hypertens. 1998; 16(8): 1103–1112.
  17. Prescott E, Hippe M, Schnohr P, et al. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ. 1998; 316(7137): 1043–1047.
  18. Taylor T, Lader D, Bryant A, et al. Smoking-Related behaviour and attitudes, 2005. London: Office for National Statistics. 2006.
  19. West R. Key performance indicators: findings from the Smoking Toolkit Study. http:// www.smokinginengland.info.
  20. He J, Vupputuri S, Allen K, et al. Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. N Engl J Med. 1999; 340(12): 920–926.
  21. Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ. 1997; 315(7114): 973–980.
  22. European Heart Network. Diet, Physical Activity and Cardiovascular Disease Prevention in Europe. Brussels, Belguim: European Heart Network. 2011.
  23. Oreopoulos A, Padwal R, Norris CM, et al. Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity (Silver Spring). 2008; 16(2): 442–450.
  24. Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010; 363(23): 2211–2219.
  25. Mihaylova B, Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 380(9841): 581–590.
  26. Robinson JG, Wang S, Smith BJ, et al. Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. J Am Coll Cardiol. 2009; 53(4): 316–322.
  27. Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J. 2013; 34(45): 3478–3490.
  28. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015; 372(25): 2387–2397.
  29. Sabatine MS, Giugliano RP, Wiviott SD, et al. Open-Label Study of Long-Term Evaluation against LDL Cholesterol (OSLER) Investigators. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med. 2015; 372(16): 1500–1509.
  30. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017; 376(18): 1713–1722.
  31. Schmidt AF, Pearce LS, Wilkins JT, et al. PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017; 4(13): CD011748–1055.
  32. Schwartz GG, Steg PG, Szarek M, et al. ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018; 379(22): 2097–2107.
  33. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  34. Savarese G, De Ferrari GM, Rosano GMC, et al. Safety and efficacy of ezetimibe: A meta-analysis. Int J Cardiol. 2015; 201: 247–252.
  35. Holman RR, Paul SK, Bethel MA, et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 837–853.
  36. Patel A, MacMahon S, Chalmers J, et al. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358(24): 2560–2572.
  37. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998; 352(9131): 854–865.
  38. Gumprecht J, Nabrdalik K. Hypoglycemia in patients with insulin‑treated diabetes. Pol Arch Med Wewn. 2016; 126(11): 870–878.
  39. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004; 364(9435): 685–696.
  40. Collins R, Armitage J, Parish S, et al. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003; 361(9374): 2005–2016.
  41. Zinman B, Wanner C, Lachin J, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015; 373(22): 2117–2128.
  42. Neal B, Perkovic V, Mahaffey KW, et al. CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377(7): 644–657.
  43. Cavender MA, Norhammar A, Birkeland KI, et al. SGLT-2 Inhibitors and Cardiovascular Risk: An Analysis of CVD-REAL. J Am Coll Cardiol. 2018; 71(22): 2497–2506.
  44. Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009; 373(9678): 1849–1860.
  45. Mehta SR, Tanguay JF, Eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010; 376(9748): 1233–1243.
  46. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without st-segment elevation. N Engl J Med. 2001; 345(7): 494–502.
  47. Wiviott S, Braunwald E, McCabe C, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357(20): 2001–2015.
  48. Wallentin L, Becker R, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361(11): 1045–1057.
  49. O'Donoghue ML, Braunwald E, Antman EM, et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet. 2009; 374(9694): 989–997.
  50. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA, ACCF/ACG/AHA. ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010; 122(24): 2619–2633.
  51. Bhatt D, Cryer B, Contant C, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010; 363(20): 1909–1917.
  52. Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001; 358(9281): 527–533.
  53. Steinhubl SR, Berger PB, Mann JT, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002; 288(19): 2411–2420.
  54. Eikelboom J, Connolly S, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017; 377(14): 1319–1330.
  55. Anand SS, Caron F, Eikelboom JW, et al. Major adverse limb events and mortality in patients with peripheral artery disease: the compass trial. J Am Coll Cardiol. 2018; 71(20): 2306–2315.
  56. Bonaca M, Bhatt D, Cohen M, et al. Long-Term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015; 372(19): 1791–1800.
  57. Valgimigli M, Bueno H, Byrne RA, et al. [2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS]. Kardiol Pol. 2017; 75(12): 1217–1299.
  58. Bhatt D, Cryer B, Contant C, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010; 363(20): 1909–1917.
  59. Costa F, Tijssen JG, Ariotti S, et al. Incremental Value of the CRUSADE, ACUITY, and HAS-BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy. J Am Heart Assoc. 2015; 4(12).
  60. Palmerini T, Della Riva D, Benedetto U, et al. Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. Eur Heart J. 2017; 38(14): 1034–1043.
  61. Reeder GS, Lengyel M, Tajik AJ, et al. Mural thrombus in left ventricular aneurysm: incidence, role of angiography, and relation between anticoagulation and embolization. Mayo Clin Proc. 1981; 56(2): 77–81.
  62. Keeley EC, Hillis LD. Left ventricular mural thrombus after acute myocardial infarction. Clin Cardiol. 1996; 19(2): 83–86.
  63. Kirchhof P, Benussi S, Kotecha D, et al. [2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS]. Kardiol Pol. 2016; 74(12): 1359–1469.
  64. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018; 39(3): 213–260.
  65. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Pressure. 2013; 23(1): 3–16.
  66. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010; 55(2): 399–407.
  67. Podolec P, Filipiak KJ, Undas A, et al. Polish forum for prevention guidelines on prophylactic pharmacotherapy: update 2017. Kardiol Pol. 2017; 75(5): 508–511.
  68. Anderson L, Taylor R. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014.
  69. Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease. J Am Coll Cardiol. 2016; 67(2): 1–12.
  70. Anderson L, Sharp GA, Norton RJ, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017; 6: CD007130.
  71. Clark RA, Conway A, Poulsen V, et al. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015; 22(1): 35–74.
  72. Karmali KN, Davies P, Taylor F, et al. Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014(6): CD007131.
  73. McAlister FA, Lawson FM, Teo KK, et al. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ. 2001; 323(7319): 957–962.
  74. Murchie P, Campbell NC, Ritchie LD, et al. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. BMJ. 2003; 326(7380): 84–528.
  75. Long L, Anderson L, Dewhirst AM, et al. Exercise-based cardiac rehabilitation for adults with stable angina. Cochrane Database Syst Rev. 2018; 2: CD012786.
  76. Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017; 377(12): 1119–1131.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl