Lifestyle improvements and medication use could lead to healthy years of life after a heart attack


Adhering to lifestyle advice and medication could extend seven healthy years of life after a heart attack, according to a study presented at ESC’s 2021 Congress.

Most heart attack patients remain at high risk of having a second attack a year later. Our study suggests that improvements in both lifestyle and medication use could lower this risk, with a gain in years of life without a cardiovascular event. “

Dr. Tinka Van Trier, study author, Amsterdam University Medical Center, Netherlands

The INTERHEART study previously showed that 80–90% of the risk of heart attack can be influenced by controlling factors such as smoking, unhealthy diet, abdominal obesity, inadequate physical activity, high blood pressure, diabetes and elevated blood lipid levels. Such management consists of two main strategies: lifestyle change and medication.

However, the RESPONSE studies showed that programs designed to help patients improve their lifestyle and optimize their medication rarely achieve adequate levels of these risk factors after a heart attack. Therefore, the “residual risk”, i.e. the risk of another heart attack that remains after conventional treatment, is high to very high in a large number of patients. Dr. Van Trier said: “This study was carried out to quantify this residual risk and to assess to what extent it could be reduced by optimal management.”

The study summarized data from 3,230 patients who had a heart attack or who received stenting or bypass surgery. The mean age was 61 years and 24% were women. On average one year after the cardiac event, almost one in three (30%) continued to smoke, 79% were overweight and 45% reported insufficient physical activity. Only 2% met treatment goals for blood pressure, LDL (“bad”) cholesterol, and glucose levels – with 40% having high blood pressure and 65% having high LDL cholesterol. However, the use of preventive drugs was common: 87% were taking antithrombotic drugs, 85% were taking lipid-lowering drugs, and 86% were taking antihypertensive drugs.

Using the SMART-REACH model, the researchers calculated the lifetime risk of heart attack, stroke or death from cardiovascular diseases and estimated changes in healthy years of life, ie without cardiac events, when changing or optimizing lifestyle or medication. The model includes the following treatment goals: 1) no smoking; 2) antithrombotic therapy with two antiplatelet agents; 3) lipid lowering drugs (high intensity statin, ezetimibe, and PCSK9 inhibitor); 4) systolic blood pressure below 120 mmHg; 5) in diabetics, use of GLP1 agonists and SGLT2 inhibitors and controlled blood sugar (HbA1c below 48 mmol / mol).

Dr. Van Trier explains: “The model does not take into account all lifestyle recommendations because there is a lack of quantitative data to calculate gains in healthy years of life. However, that does not mean that recommendations about a healthy diet, normal weight, and regular physical activity are not useful. “Less important in reducing your risk.”

The estimated average remaining life risk was 54% – meaning half would have a heart attack, stroke, or cardiovascular disease at some point in their life. If the treatment of the patients in the study were optimized to meet all of the goals in the model, the average risk would drop to 21% (every fifth patient).

Dr. Van Trier said: “The results show that despite current efforts to reduce the likelihood of new events after a heart attack, there is still considerable room for improvement. Our analysis suggests that the risk of another cardiovascular event could be cut in half on average ”if therapies were applied or intensified. For the individual patient, this means a gain of an average of 7.5 event-free years. “


European Society of Cardiology