Abstract
Introduction: The increased coronary heart disease (CHD) morbidity rate, worldwide, as well as the progressive aging of the population, is considered as the greatest public health burden, in both developed and developing countries. Additionally, CHD is responsible for almost 20% of deaths in Europe annually, while a significant number of them is attributed to modifiable risk factors related to lifestyle habits. However, the long term impact of socio-economic and behavioral determinants has been scarcely evaluated and examined, in the context of secondary disease prevention, posing an innovative research project. Thus, the aim of the present work was to investigate the association between behavioral/socio-economic characteristics and the 10-year (2004-2014) Acute Coronary Syndrome (ACS) prognosis, among cardiac patients.Methodology: From October 2003 to September 2004, almost all consecutive patients (n = 2,172) diagnosed with ACS (i.e. acute myocardial infarction (AMI) or unstable angi ...
Introduction: The increased coronary heart disease (CHD) morbidity rate, worldwide, as well as the progressive aging of the population, is considered as the greatest public health burden, in both developed and developing countries. Additionally, CHD is responsible for almost 20% of deaths in Europe annually, while a significant number of them is attributed to modifiable risk factors related to lifestyle habits. However, the long term impact of socio-economic and behavioral determinants has been scarcely evaluated and examined, in the context of secondary disease prevention, posing an innovative research project. Thus, the aim of the present work was to investigate the association between behavioral/socio-economic characteristics and the 10-year (2004-2014) Acute Coronary Syndrome (ACS) prognosis, among cardiac patients.Methodology: From October 2003 to September 2004, almost all consecutive patients (n = 2,172) diagnosed with ACS (i.e. acute myocardial infarction (AMI) or unstable angina (UA)) that were hospitalized in the cardiology clinics or the emergency units of 6 major General Hospitals in Greece were enrolled in the study. During 2013-14, the 10-year follow-up was performed in 1,918 participants (88% participation rate). Information regarding the clinical, socio-demographic, psychological and behavioral characteristics was obtained, through personal interview, by a standard questionnaire. The development of fatal or non-fatal ACS events was recorded through medical records or hospital registries. Logistic regression models were applied to evaluate the impact of educational, financial, psychological, physical, smoking and clinical patients’ status on the 10-year ACS prognosis had lower risk of any ACS recurrent event (fatal-non fatal), within the decade. Results: The overall fatal/non-fatal 10-year ACS incidence was n=811 (37.3%); of them 78.8% were men and 21.2% were women, (p=0.016)). Of the n=811 ACS events, 383 (47.3%) were fatal, and, thus, the overall 10-year fatal incidence was 17.7% (74,5% men and 25,5% women) (p=0,016). The median follow-up time was 8,08 years for men and 7,78 years for women, 8.4 years (p=0,07). After taking into account various potential confounders, it was observed that ACS patients in high educational level had better 10-year prognosis. Additionally, the protective role of good/very good financial status has been revealed, statistically significant results (HR=0.76, 95%CI 0.60, 0.95, p=0.01). A significant interaction was observed between depressive symptoms, marital status and the10-year ACS incidence. Specifically, among non-married, single or divorced patients, 1-point increase in the CES-D score was associated with 2% higher risk of having recurrent ACS events (HR=1.02, 95%CI 1.00, 1.04) and 4% higher risk of having fatal ACS event (HR=1.04, 95%CI 1.02, 1.06), during the decade.Regarding smoking habits, it was observed that for every 30 pack-years of smoking the associated ACS risk increased by 6% (95%CI 1.03,1.30) and for fatal ACS event by 8% (95%CI 1.03,1.63). Patients who reported exposure to secondhand smoke had 33% higher risk for any ACS event (fatal, non-fatal) (95%CI 1.12, 1.60) and 27% higher risk for fatal ACS event (95%CI 1.01, 1.60). Moreover, a significant inverse association was revealed between physical activity (moderate/HEPA vs. inactive/low) and the 10-year ACS incidence (OR=0.74 95% CI 0.53, 1.03). Evaluating the clinical factors, diabetes mellitus was highlighted as the sole aggravating clinical factor in ACS recurrent events, in relation to the other two factors (hypertension and hypercholesterolaemia). Regarding dietary habits, the cardioprotective role of exclusive olive oil consumption vs. a combination of added fats was observed, even among obese patients. Furthermore, patients with even 1 portion of sweet /week consumption experienced 23% higher risk of a recurrent ACS event, as compared with the ones who reported never/rare consumption (95% CI 0.99, 1.53), while patients who consumed 1-2 cups of coffee/day had 35% higher risk of recurrent fatal or non-fatal ACS episodes when compared with those who reported never/rare consumption, during the follow-up period (95%CI 1.01, 1.79).Conclusions: ACS is regarded as the most preventable, multifactorial chronic disease due to modifiable risk behaviors. The present work highlighted the significant role of socio-demographic, behavioral and clinical characteristics in the long-term cardiovascular prognosis, among ACS patients. Taking into account the demographic changes and the adverse aspects of modern lifestyle habits, it is crucial for public health strategies to be embedded within the secondary health care provision, with emphasis given on the effective management of environmental risk factors and development of primary health care services.Key words: Acute Coronary Syndrome; secondary prevention; risk factors; health promotion; primary health care services; public health.
show more
