What are "Secondary Prevention Targets" and why are they significant?
From - Rouge Valley Health System - Cardiac Rehab Services - Toronto, Ontario
In the past, your doctor has assessed your risk of cardiac events (heart attack, stroke) by the assessment of your cardiac risk factors such as high blood pressure, smoking and high cholesterol to name a few. However, we now realize that assessing risk factors alone doesn't tell us the whole story. Risk factors do not completely account for the risk of developing coronary artery disease, and do not accurately predict the annual risk of having a cardiac event.
Large clinical trials have demonstrated that secondary prevention strategies using specific treatment goals may reduce the annual risk of future cardiac events and may actually slow the progression of heart disease.
Secondary prevention strategies include medications that your doctor prescribes for you, as well as lifestyle behaviours. They encompass some of the traditional controllable risk factors previously used such as smoking, blood pressure, cholesterol levels, regular aerobic exercise etc. Failure to achieve the documented targets may reduce your benefit of reducing your cardiac risk.
Some of the medications that your doctor will prescribe, have specific secondary prevention targets or doses. Clinical trials have demonstrated that benefits from the medications are dose specific. For example, the HOPE study demonstrated that Altace 10 mg once a day had a significant reduction in cardiac events for people with known cardiovascular disease or diabetes. There is evidence that reduced doses of these medications may not have the same benefit. For this reason, your doctor will be working with you to try and reach the specified target doses.
Below is a table outlining the secondary
prevention targets that you should be working towards. There are
many strategies for reaching these targets and your doctor and health
care team members will work with you to achieve these targets. You
will notice that there is space in this chart for you to write in
your current status. If you do not know your current status on these
secondary prevention targets, ask your doctor or health care team
Disability & Death Rate
Life expectancy has increased considerably in the last decade. Information from research studies such as the Harvard Longitudinal Study, indicate that we can expect to live to 85 years when one is congruent with the "predictors."
All That Matters Is Systolic Blood Pressure (At least for those over 50 years of age)
High blood pressure (hypertension) in younger adults is caused by narrowing of the arteries and smaller arteries. In older adults the larger arteries play a more significant role in one's blood pressure. These large arteries become stiffer, lose some of their elasticity and do not "give" when the heart contracts which results in a higher blood pressure followed by a lower diastolic blood pressure. Usually the diastolic pressure has been used to determine if treatment is necessary and systolic pressure ignored.
Tim Russert: A Tragedy - Sudden Death But Was It Unannounced?
It is difficult to understand the loss of an adult in the most productive phase of life. In general, it is believed that living to 85 years of age is an expectation, especially if following the predictors set forth by George Valliant, Director of the Harvard Longitudinal Study, and author of AGING WELL.
Can't Quit Even If I Wanted To
Joseph Difranza has reported a possible explanation as to why it is so difficult to quit smoking, even when a smoker no longer gets pleasure from smoking. Biological evidence shows that when an individual smokes a cigarette, the nicotine level rises in the blood.
Friends, Family, the Framingham Heart Study and Obesity 2007
The "person-to-person" spread of obesity is a recent observation of Nicholas Christakis and James Fowler (2007). These investigators examined the data from the Framingham Heart Study which included ~ 12,000 subjects.