“Secondary Prevention” of Myocardial Infarction

Abstract

According to data from the prethrombolytic era, a patient who survives a first myocardial infarction (MI) faces nearly an 80% chance of another cardiovascular disease (CVD) event within the next 5 yr (1). More contemporary data indicate that within 6 yr of an MI, approx 20% of men and 35% of women will sustain another heart attack with similar percentages developing congestive heart failure (CHF) (2). Thus, the diagnosis of an MI brings with it the high likelihood of recurrent cardiovascular events, compounding morbidity, and probable ultimate fatality. Viewed in this way, CVD is, in fact, much like many forms of cancer, although the reaction of many patients to those two diagnoses can be quite different. Perhaps this is related to antiquated notions, propagated at times by physicians, that mechanical cardiovascular therapies, such as bypass surgery and angioplasty, can “fix” the cardiovascular problem. The myriad of therapeutic options available to the cardiologist and their patients might further fuel such concepts. In reality, modern medicine might be better at “curing” some types of cancer than reversing advanced atherosclerosis. CVD patients suffer a chronic insidious disease that requires aggressive interventions to alter the complex process that led to its generation, propagation, and recurrence; steps untouched by acute mechanical treatments restoring patency or providing alternate paths of blood flow. Fortunately, the number of interventions, both medical and lifestyle, for so-called secondary prevention also continues to grow. Similarly, our understanding of atherogenesis and the development of acute coronary syndromes is also progressing, creating hope for the development of new, and perhaps more effective, therapeutic approaches. We are also left with the considerable challenge of applying those interventions known to reduce cardiovascular risk.