Introduction: Ischaemic heart disease is one of the main causes of morbidity and mortality and health costs in Spain.1-4 The TRANSLATE-ACS5 study and EUROASPIRE V6 show that we are far from reaching the secondary prevention goals.
Objectives: Determine the degree of achievement of secondary prevention targets. Assess the influence of the SARS-CoV-2 pandemic
Methods: Age 40-75. Diagnosis of ischaemic heart disease 2014-2018. Zone IV.6 (Asturias). 206 patients, with a 10% loss. Data collection: February–March 2019 and January–February 2022.
Variables: age, sex, type of event, prior cardiovascular risk factors (CVRF) (hypertension, diabetes, dyslipidaemia, obesity, and smoking), associated diseases (stroke, peripheral vascular disease and chronic kidney disease), weight, height, body mass index, systolic and diastolic blood pressure (SBP, DBP), HDL, LDL and total cholesterol, triglycerides, glycaemia, HbA1c in diabetics, creatinine, glomerular filtration rate, treatment (antiplatelet/anticoagulant, statins, ezetimibe, β-blockers, ACEi/ARBs) and treatment adherence.
Analysis: medians and standard deviation (continuous variables). Absolute numbers and percentages (categorical variables). Student’s t-test (compare medians). Chi-square test (association between variables). Final analysis by intention-to-treat.
Limitations: missing records, patients not attending or unable to be contacted.
Results: Majority male (68.8%). Average age 62.2 ± 8.2, women being older (p=0.004). Myocardial infarction more in men (59.4%). 61.3% dyslipidaemia, 53.8% hypertension, 37.1% obesity, 32.8% smokers and 35.3% diabetes. 18.8% prior CVRFs. Statins: 97.8% in 2019, decreasing (p=0.004) to 90.1%, although statin-ezetimibe combination use increased (43% vs 25.1%). Most used: atorvastatin (78.5% pre-pandemic, 69.4% post-pandemic). A higher proportion of men (p=0.011) used high-potency (78% vs 58.6%), with use equalising (75% vs 77.6%) due to an increase among women (p=0.019).
Obesity increased in both sexes by 5%. Smoking 32.8% at diagnosis, 16.9% in 2019, but rose again in 2022 (19.9%). 79.6% SBP control decreased (79.6% vs 66.7%) (p=0.006). DBP control 90%. Blood pressure <140/90 mmHg decreased in 2022 (66.1% vs 78.5%).
Diabetics with HbA1c <7% decreased in 2022 (54.9% vs 75%) (p=0.039). LDL <55 mg/dL increased (24.2% vs 33.3%), with better results in men.
Conclusion: Patients with ischaemic heart disease reach suboptimal levels of control in secondary prevention. We must increase the potency of statins, the use of associations and implement strategies to improve lifestyles and CVRF in both primary and secondary prevention.