Population Health Research Institute, Hamilton Health Sciences-McMaster University, ON, Canada, L8L 2X2.
Curr Cardiol Rep. 2011 Aug;13(4):287-95. doi: 10.1007/s11886-011-0190-5.
Medical and lifestyle secondary prevention strategies are essential components for reducing cardiovascular risk, irrespective of whether revascularization is performed. In patients with coronary artery disease (CAD), recent clinical trials have further clarified the management of lipid optimization, renin-angiotensin-aldosterone system inhibition, antiplatelet therapy, and diabetes. Still, many questions remain with regard to optimal secondary prevention strategies in patients with CAD. Despite the significant reductions in cardiovascular morbidity and mortality with secondary prevention therapies demonstrated in clinical trials, long-term adherence to these interventions remains relatively low, with reasons being multifactorial. One promising method to improve compliance is the use of trained nurses/case managers to routinely follow medications, and provide both lifestyle and behavioral counseling. Implementation of this strategy led to significant improvements in medication compliance and risk factor optimization, although these results require confirmation in a randomized clinical study. Given that poor compliance has been associated with worsening cardiovascular outcomes, effective CAD management should include strategies for improving patient adherence to therapies that have proven benefits.
医疗和生活方式的二级预防策略是降低心血管风险的重要组成部分，无论是否进行血运重建。在患有冠状动脉疾病（CAD）的患者中，最近的临床试验进一步阐明了血脂优化、肾素-血管紧张素-醛固酮系统抑制、抗血小板治疗和糖尿病的管理。然而，对于 CAD 患者的最佳二级预防策略仍存在许多问题。尽管临床试验证明了二级预防治疗可显著降低心血管发病率和死亡率，但这些干预措施的长期依从性相对较低，原因是多方面的。一种有前途的提高依从性的方法是使用经过培训的护士/个案经理来常规监测药物，并提供生活方式和行为咨询。尽管这些结果需要在随机临床试验中得到证实，但实施这一策略导致了药物依从性和危险因素优化的显著改善。鉴于依从性差与心血管结局恶化有关，有效的 CAD 管理应包括改善患者对已证明有益的治疗方法的依从性的策略。
