Cortés-Beringola Alejandro, Fitzsimons Donna, Pelliccia Antonio, Moreno Guillermo, Martín-Asenjo Roberto, Bueno Héctor
1 Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
2 School of Nursing and Midwifery, Queens University, Belfast, UK.
Eur J Prev Cardiol. 2017 Jun;24(3_suppl):22-28. doi: 10.1177/2047487317704954.
The prognosis of patients after acute coronary syndromes is still suboptimal, mainly due to the risk of recurrent adverse coronary events, which is greatest during the first year, but persists over one's lifetime. Meaningful progress in preventing cardiovascular events has been achieved. However, there remains much room for improvement by embracing innovative therapies and investing in multidisciplinary approaches. Pharmacological interventions focused on optimising antithrombotic and lipid-lowering therapies are both pillars of secondary prevention that have seen recent ground-breaking advances. Moreover, new approaches in diabetic patients with cardiovascular disease and new targets for anti-inflammatory treatment may significantly improve prevention strategies in the future. However, pharmacological treatments are expensive and can have significant side effects. Developing better tools in order to identify high-risk patients and promote more personalised strategies for each patient should be an absolute priority. Furthermore, adherence to medication is still low and represents a real challenge; several strategies to improve low adherence to treatment are currently under discussion. Non-pharmacological interventions are also essential. Improving communication with patients and advanced surveillance for those secondary risk factors that may negatively impact prognosis are crucial. Encouraging multidisciplinary teams that work effectively to optimise all aspects of secondary prevention, including a cardiac rehabilitation programme, is the optimal approach. Current secondary prevention strategies and suggestions for areas of improvement are discussed in this manuscript. However, the question remains: will research in secondary prevention continue to focus on stronger and more expensive drugs, or is it time for us to embrace a more patient-centred clinical and research model?
急性冠脉综合征患者的预后仍不尽人意，主要原因是冠状动脉不良事件复发的风险，这种风险在第一年最大，但会持续一生。在预防心血管事件方面已取得了有意义的进展。然而，通过采用创新疗法和投资多学科方法，仍有很大的改进空间。专注于优化抗血栓和降脂治疗的药物干预是二级预防的两大支柱，最近都取得了突破性进展。此外，针对心血管疾病糖尿病患者的新方法和抗炎治疗的新靶点可能会在未来显著改善预防策略。然而，药物治疗昂贵且可能有显著的副作用。开发更好的工具以识别高危患者并为每位患者推广更个性化的策略应是绝对优先事项。此外，药物依从性仍然很低，这是一个现实挑战；目前正在讨论几种提高低治疗依从性的策略。非药物干预也至关重要。改善与患者的沟通以及对可能对预后产生负面影响的那些二级危险因素进行高级监测至关重要。鼓励多学科团队有效合作以优化二级预防的各个方面，包括心脏康复计划，是最佳方法。本手稿讨论了当前的二级预防策略以及改进领域的建议。然而，问题仍然存在：二级预防研究是否会继续专注于更强效、更昂贵的药物，还是我们该采用更以患者为中心的临床和研究模式了？
