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21-02-2010 | Cardiology | Article

Lifestyle changes after ACS halve risk for CV events


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MedWire News: Patients who follow advice on diet, exercise, and smoking cessation as well as using secondary preventive medications after acute coronary syndrome (ACS) substantially reduce their risk for subsequent major cardiovascular (CV) events, indicate results from a large, international study.

The study showed that patients who adhered to both diet and exercise advice had a 54% lower risk for major CV events than those who did not, while those who quit smoking had a 43% lower risk for myocardial infarction (MI) compared with persistent smokers, even after accounting for use of interventional and pharmacologic therapies.

Commenting on the research for MedWire News, Joep Perk (Linnaeus University, Kalmar, Sweden) said the results were very exciting. “This really puts all the work we have been doing with patients in lifestyle after MI in a stronger scientific perspective," he said. "It is important work and deserves to be put in the spotlight.”

Perk emphasized: “Drugs and lifestyle are inseparable in getting the best results for your cardiac patients. If you only concentrate on treating patients with drugs and forget about lifestyle you miss half the effects. So doctors who do not do that are not practicing according to the scientific evidence.”

The OASIS (Organization to Assess Strategies in Acute Ischemic Syndromes) 5 trial compared fondaparinux with enoxaparin in 20,078 patients with unstable angina or MI without ST-segment elevation.

For the current study, which appears in the journal Circulation, Clara Chow (Hamilton General Hospital, Ontario, Canada) and colleagues analyzed the risk for short-term (less than 6 months) CV events in 18,809 patients in OASIS 5 who were alive and reported on lifestyle behavioral modification at the 30-day follow-up.

Among this group, 455 (2.4%) patients had a subsequent MI, 120 (0.6%) had a subsequent stroke, and 481 (2.6%) died by the end of the 6-month follow-up period.

Chow and team report that 64.8% of patients who smoked reported quitting, while 28.5% of patients reported adherence to neither diet nor exercise, 41.6% adherence to either diet or exercise, and 29.9% adherence to both. In contrast, 96.1% reported antiplatelet use, 78.9% statin use, and 72.4% ACE inhibitor or angiotensin receptor blocker use.

Analysis showed that, after adjusting for CV risk factors, region, percutaneous coronary intervention or coronary artery bypass graft surgery within 30 days, and use of recommended medications, patients who quit smoking had an odds ratio (OR) of 0.57 for MI (p=0.015) and an OR of 0.74 for the composite of MI, stroke, or death (p=0.07) compared with persistent smokers.

Meanwhile, patients who adhered to both diet and exercise had an OR for MI of 0.52 and an OR for MI, stroke, or death of 0.46 (both p<0.0001) compared with patients who did not adhere to either diet or exercise modifications.

For each category of smoker, change in diet and exercise had additive effects. For example, compared with never smokers who adhered to both diet and exercise modification, never smokers who adhered to either diet or exercise advice had a two-fold increased risk for a repeat CV event, while persistent smokers who did not modify diet or exercise had a nearly four-fold increased risk.

Perk told MedWire that although self-report on behavioral measures can be unreliable it may well have led to an underestimate of the benefits of lifestyle modification here.

The study also highlighted that uptake of lifestyle changes remains very low, mainly a problem of implementing and following up with counseling, according to Perk.

He said: “The EUROACTION study showed that nurse-led programs work fairly well. You need programs that are cheap and easily accessible so patients find it relatively easy to adhere to them.”

Perk indicated that the research will be vital in raising the profile of lifestyle modification in secondary prevention. “The guidelines are already clear – the level of evidence is strengthened by this article but it will not change them, it will simply say ‘apply them,’” he said.

“You have to point the finger in the direction of the healthcare systems and say – now we know what you can do, so see to it that you deliver it also.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Caroline Price

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