The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) – the study protocol of a randomised, controlled trial Cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease in Canada. Rationale and design of a randomized trial on the effectiveness of aerobic interval training in patients with coronary artery disease: the SAINTEX-CAD study. Randomized controlled trial of an informatics-based intervention to increase statin prescription for secondary prevention of coronary disease Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD) - rationale and design of a multicenter, randomized trial in depressed patients with CAD. Smoking cessation in women with cardiac risk: a comparative study of two theoretically based therapies. Consequence of resistance training on body composition and coronary artery disease risk. Technology Evaluation: A Randomized Trial of Electronic Clinical Reminders to Improve Quality of Care for Diabetes and Coronary Artery Disease Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial Secondary prevention with folic acid: effects on clinical outcomes. Secondary prevention and lipid lowering: results and implications. Effects of a Problem-Based Learning Rehabilitation Programme on Quality of Life in Patients with Coronary Artery Disease Serum cholesterol, lifestyle, working capacity and quality of life in patients with coronary artery disease. Experiences from a hospital-based secondary prevention programme. Use of electron beam tomography data to develop models for prediction of hard coronary events. Fried-food consumption and risk of type 2 diabetes and coronary artery disease: a prospective study in 2 cohorts of US women and men. Computerized community cholesterol control (4C): meeting the challenge of secondary prevention. Apixaban in patients with atrial fibrillation and prior coronary artery disease: insights from the ARISTOTLE trial. Effects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). alpha-Linolenic acid intake is not beneficially associated with 10-y risk of coronary artery disease incidence: the Zutphen Elderly Study. [Impact of multifactor intensive intervention on self management, risk factor control and outcome of post percutaneous transluminal coronary intervention patients].
Background To help patients with coronary artery disease ( CAD ) benefit from the positive health effects attained by exercise-based cardiac rehabilitation ( CR ) , adherence to these programmes according to international guidelines is important . Strategies to increase adherence to exercise-based CR are mainly an unexplored area . The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy , containing goal - setting , self-monitoring and feedback , with the aim of improving rehabilitation outcomes for exercise-based CR , compared with usual care . Methods This is a r and omised , controlled trial . A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden . Patients are r and omised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy , in addition to usual care for 4 months . Outcome assessment at baseline , 4 and 12 months includes submaximal aerobic capacity ( primary outcome ) , exercise adherence , muscle endurance , level of physical activity , biomarkers , anxiety and depression , health-related quality of life , patient enablement and self-efficacy ( secondary outcomes ) . Discussion This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes . The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.Trial registration The study include all items from the World Health Organization Trial Registration Data Set . Trial registration number : NCT02895451 , 2016 - 08 - 16 , retrospectively registered OBJECTIVE To determine the cost-effectiveness of simvastatin in the secondary prevention of coronary artery disease ( CAD ) in Canada . DESIGN Cost-effectiveness model based on results from the Sc and inavian Simvastatin Survival Study ( 45 study ) and cost and re source utilization data from Canadian sources to simulate the economic impact of long-term simvastatin treatment ( 15 years ) . PATIENTS Subjects with mean age of 59.4 years at recruitment into 4S study . OUTCOME MEASURES Overall death rate and incidence of 5 major nonfatal events associated with CAD : myocardial infa rct ion , coronary artery bypass grafting , percutaneous transluminal coronary angioplasty , stroke and transient ischemic attack . Direct medical costs associated with CAD were assessed from the perspective of provincial ministries of health ( i.e. , costs borne by the ministries ) ; the impact of simvastatin treatment on these costs was determined . RESULTS The 4S study , with a median follow-up of 5.4 years , showed significantly reduced mortality and morbidity among the patients given simvastatin compared with the control subjects . Three premises were design ed to predict the consequences of simvastatin treatment of CAD in Canada over 15 years , 10 years beyond the end of the 4S study . The 2 most probable premises , which assumed that the clinical benefits of simvastatin would be cumulative for either the first 10 years or the full 15 years of the model , had incremental costs per year of life gained ( cost-effectiveness ratio ) of $ 9867 and $ 6108 respectively . CONCLUSION This model suggests that simvastatin provides a cost-effective approach to the long-term prevention of secondary CAD in Canada BACKGROUND Exercise-based cardiac rehabilitation is considered an important adjunct treatment and secondary prevention measure in patients with coronary artery disease ( CAD ) . However , the issues of training modality and exercise intensity for CAD patients remain controversial . OBJECTIVE Main aim of the present study is to test the hypothesis that aerobic interval training ( AIT ) yields a larger gain in peak aerobic capacity ( peakVO2 ) compared to a similar training programme of moderate continuous training ( MCT ) in CAD patients . STUDY DESIGN In this multicentre study stable CAD patients with left ventricular ejection fraction>40 % will be r and omized after recent myocardial infa rct ion or revascularization ( PCI or CABG ) to a supervised 12-week programme of three weekly sessions of either AIT ( 85 - 90 % of peak oxygen uptake [ peakVO2 ] , 90 - 95 % of peak heart rate ) or MCT ( 60 - 70 % of peakVO2 , 65 - 75 % of peak heart rate ) . The primary endpoint of the study is the change of peakVO2 after 12 weeks training . Secondary endpoints include safety , changes in peripheral endothelial vascular function , the evolution of traditional cardiovascular risk factors , quality of life and the number and function of circulating endothelial progenitor cells as well as endothelial microparticles . Possible differences in terms of long-term adherence to prescribed exercise regimens will be assessed by regular physical activity question naires , accelerometry and re assessment of peakVO2 12 months after r and omization . A total number of 200 patients will be r and omized in a 1:1 manner ( significance level of 0.05 and statistical power of 0.90 ) . Enrolment started December 2010 ; last enrolment is expected for February 2013 OBJECTIVE : Suboptimal treatment of hyperlipidemia in patients with coronary artery disease ( CAD ) is well documented . We report the impact of a computer-assisted physician-directed intervention to improve secondary prevention of hyperlipidemia . DESIGN AND SETTING : Two hundred thirty-five patients under the care of 14 primary care physicians in an academically affiliated practice with an electronic health record were enrolled in this proof-of-concept physician-blinded r and omized , controlled trial . Each patient with CAD or risk equivalent above National Cholesterol Education Program-recommended low-density lipoprotein ( LDL ) treatment goal for greater than 6 months was r and omized , stratified by physician and baseline LDL . Physicians received a single e-mail per intervention patient . E-mails were visit independent , provided decision support , and facilitated “ one-click ” order writing . MEASUREMENTS : The primary outcomes were changes in hyperlipidemia prescriptions , time to prescription change , and changes in LDL levels . The time spent using the system was assessed among intervention patients . RESULTS : A greater proportion of intervention patients had prescription changes at 1 month ( 15.3 % vs 2 % , P=.001 ) and 1 year ( 24.6 % vs 17.1 % , P=.14 ) . The median interval to first medication adjustment occurred earlier among intervention patients ( 0 vs 7.1 months , P=.005 ) . Among patients with baseline LDLs > 130 mg/dL , the first postintervention LDLs were substantially lower in the intervention group ( 119.0 vs 138.0 mg/dL , P=.04 ) . Physician processing time was under 60 seconds per e-mail . CONCLUSION : A visit-independent disease management tool result ed in significant improvement in secondary prevention of hyperlipidemia at 1-month postintervention and showed a trend toward improvement at 1 year Background Coronary artery disease ( CAD ) is accountable for more than 7 million deaths each year according to the World Health Organization ( WHO ) . In a European population 80 % of patients diagnosed with CAD are overweight and 31 % are obese . Physical inactivity and overweight are major risk factors in CAD , thus central strategies in secondary prevention are increased physical activity and weight loss . Methods / Design In a r and omized controlled trial 70 participants with stable CAD , age 45–75 , body mass index 28–40 kg/m2 and no diabetes are r and omized ( 1:1 ) to 12 weeks of  intensive exercise or weight loss both succeeded by a 40-week follow-up . The exercise protocol consist of supervised aerobic interval training ( AIT ) at 85 - 90 % of VO2peak 3 times weekly for 12 weeks followed by supervised AIT twice weekly for 40 weeks . In the weight loss arm dieticians instruct the participants in a low energy diet ( 800–1000 kcal/day ) for 12 weeks , followed by 40 weeks of weight maintenance combined with supervised AIT twice weekly . The primary endpoint of the study is change in coronary flow reserve after the first 12 weeks ’ intervention . Secondary endpoints include cardiovascular , metabolic , inflammatory and anthropometric measures . Discussion The study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT . Additionally , it will provide new insight in mechanisms behind the benefits of exercise and weight loss . We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD.Trial registration Clinical Trials.gov : OBJECTIVE Depressive symptoms are highly relevant for the quality of life , health behavior , and prognosis in patients with coronary artery disease ( CAD ) . However , previous psychotherapy trials in depressed CAD patients produced small to moderate effects on depression , and null effects on cardiac events . In this multicentre psychotherapy trial , symptoms of depression are treated together with the Type D pattern ( negative affectivity and social inhibition ) in a stepwise approach . METHODS Men and women ( N=569 , age 18 - 75 years ) with any manifestation of CAD and depression scores ≥ 8 on the Hospital Anxiety and Depression Scale ( HADS ) , will be r and omized ( allocation ratio 1:1 ) into the intervention or control group . Patients with severe heart failure , acutely life-threatening conditions , chronic inflammatory disease , severe depressive episodes or other severe mental illness are excluded . Both groups receive usual medical care . Patients in the intervention group receive three initial sessions of supportive individual psychotherapy . After re-evaluation of depression ( weeks 4 - 8 ) , patients with persisting symptoms receive an additional 25 sessions of combined psychodynamic and cognitive-behavioral group therapy . The control group receives one psychosocial counseling session . Primary efficacy variable is the change of depressive symptoms ( HADS ) from baseline to 18 months . Secondary endpoints include cardiac events , remission of depressive disorder ( SCID ) and Type D pattern , health-related quality of life , cardiovascular risk profile , neuroendocrine and immunological activation , heart rate variability , and health care utilization , up to 24 months of follow-up ( IS RCT N : 76240576 ; NCT00705965 ) . Funded by the German Research Foundation This gender-specific research study compares the relative effectiveness of two theory-based interventions targeting women who smoke . Women with coronary artery disease ( CAD ; n = 53 ) or CAD risk factors ( n = 107 ) were r and omly assigned to either coping-skills Relapse Prevention ( RP ) treatment or an educational/supportive treatment based on Health Belief Model ( HBM ) principles . RP was comparable , but not superior to HBM treatment , as indicated by the lack of differential smoking outcomes at 3 and 6 months .  RP was more effective than HBM  for women with low self-efficacy , as predicted . The presence of a smoking-related disease had a substantial effect on smoking status , in that the odds of being abstinent at 6 months were 2.2 times greater for non-diagnosed women when compared with CAD women . These findings indicate that more potent relapse prevention interventions are needed to increase cessation rates in women who smoke , especially those with established heart disease Coronary artery disease ( CAD ) is a substantial cause of death and disability in South Africa and Western society , with research showing obesity to be one of the most common CAD risk factors . Furthermore , obesity is speculated to be the fastest-growing CAD risk factor and to become the most prevalent CAD risk factor . Research on obesity is therefore essential , and we propose some preventative measures that will hopefully limit the expansion of this risk factor for CAD . Most of the literature has focused primarily on aerobic modes of exercise . The aim of this study , therefore , was to investigate whether resistance training would improve body composition .  Twenty-eight males were matched by age , percentage of body fat and waist-to-hip ratio and r and omly assigned either to a resistance-training group ( n = 13 ) or a control group ( n = 15 ) . Each subject 's body mass , percentage body fat , lean mass , fat mass , waist-to-hip ratio and body mass index were assessed both pre- and post-experimentally following the eight-week experimental period . The resistance-training group trained three times weekly at 60 % of their one-repetition maximum using nine resistance exercises . Each exercise was performed for three sets of 15 repetitions each , whereas the control group did not exercise over this period . The dependent t-test indicated that resistance training significantly changed body mass , percentage of body fat , lean mass and fat mass ( all had a p-value of 0.00 ; p < or= 0.01 ) . Furthermore , the independent t-test demonstrated that lean mass , fat mass and percentage of body fat were statistically significantly different between the control and resistance-training groups . In conclusion , resistance training improved four of the six measured body composition variables , therefore implying that resistance training does in fact improve the majority of body composition variables and therefore CAD risk OBJECTIVE The aim of this study was to evaluate the impact of an integrated patient-specific electronic clinical reminder system on diabetes and coronary artery disease ( CAD ) care and to assess physician attitudes toward this reminder system . DESIGN We enrolled 194 primary care physicians caring for 4549 patients with diabetes and 2199 patients with CAD at 20 ambulatory clinics . Clinics were r and omized so that physicians received either evidence -based electronic reminders within their patients ' electronic medical record or usual care . There were five reminders for diabetes care and four reminders for CAD care . MEASUREMENTS The primary outcome was receipt of recommended care for diabetes and CAD . We created a summary outcome to assess the odds of increased compliance with overall diabetes care ( based on five measures ) and overall CAD care ( based on four measures ) . We surveyed physicians to assess attitudes toward the reminder system . RESULTS Baseline adherence rates to all quality measures were low . While electronic reminders increased the odds of recommended diabetes care ( odds ratio [ OR ] 1.30 , 95 % confidence interval [ CI ] 1.01 - 1.67 ) and CAD ( OR 1.25 , 95 % CI 1.01 - 1.55 ) , the impact of individual reminders was variable . A total of three of nine reminders effectively increased rates of recommended care for diabetes or CAD . The majority of physicians ( 76 % ) thought that reminders improved quality of care . CONCLUSION An integrated electronic reminder system result ed in variable improvement in care for diabetes and CAD . These improvements were often limited and quality gaps persist UNLABELLED Patients with coronary artery disease ( CAD ) are at high risk of recurrent events . A healthy lifestyle can significantly reduce this risk . A previous trial , R and omized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ( RESPONSE ) , demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors . However , lifestyle-related risk factors , including smoking , overweight , and physical inactivity , were common and remained largely unchanged at follow-up in most patients ( 66 % ) . The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD . We are conducting a multicenter ( n = 15 ) , r and omized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs , aim ed at patients and their partners , on top of usual care . These programs are aim ed at smoking cessation ( Luchtsignaal ( ® ) ) , weight loss ( Weight Watchers ( ® ) ) , and improving physical activity ( Philips DirectLife ( ® ) ) . OUTCOMES The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2 , and a relative increase of at least 30 % in this proportion is considered clinical ly relevant BACKGROUND The rapid emergence of coronary artery disease ( CAD ) in south Asian people is not explained by conventional risk factors . In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid , we assessed the benefits of this diet for patients at high risk of CAD . METHODS We did a r and omised , single-blind trial in 1000 patients with angina pectoris , myocardial infa rct ion , or surrogate risk factors for CAD . 499 patients were allocated to a diet rich in whole grains , fruits , vegetables , walnuts , and almonds . 501 controls consumed a local diet similar to the step I National Cholesterol Education Program ( NCEP ) prudent diet . FINDINGS The intervention group consumed more  fruits , vegetables , legumes , walnuts , and almonds  than did controls ( 573 g [ SD 127 ] vs 231 g [ 19 ] per day p<0.001 ) . The intervention group had an increased intake of whole grains and mustard or soy bean oil . The mean intake of alpha-linolenic acid was two-fold greater in the intervention group ( 1.8 g [ SD 0.4 ] vs 0.8 g [ 0.2 ] per day , p<0.001 ) . Total cardiac end points were significantly fewer in the intervention group than the controls ( 39 vs 76 events , p<0.001 ) . Sudden cardiac deaths were also reduced ( 6 vs 16 , p=0.015 ) , as were non-fatal myocardial infa rct ions ( 21 vs 43 , p<0.001 ) . We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups , but especially in the intervention diet group . In the treatment group , patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group . INTERPRETATION An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet OBJECTIVES We sought to conduct a r and omized trial with folic acid 0.5 mg/day in a patient population with stable coronary artery disease ( CAD ) . BACKGROUND Folic acid has favorable effects on vascular endothelium and lowers plasma homocysteine levels . In addition , homocysteine appears to be an independent risk factor for atherosclerotic disease . However , the value of folic acid in secondary prevention had seldom been tested . METHODS In this open-label study , 593 patients were included ; 300 were r and omized to folic acid and 293 served as controls .  Mean follow-up time was 24 months . At baseline all patients had been on statin therapy for a mean of 3.2 years . RESULTS In patients treated with folic acid , plasma homocysteine levels decreased by 18 % , from 12.0 + /- 4.8 to 9.4 + /- 3.5 micromol/l , whereas these levels remained unaffected in the control group ( p < 0.001 between groups ) . The primary end point ( all-cause mortality and a composite of vascular events ) was encountered in 31 ( 10.3 % ) patients in the folic acid group and in 28 ( 9.6 % ) patients in the control group ( relative risk 1.05 ; 95 % confidence interval : 0.63 to 1.75 ) . In a multifactorial survival model with adjustments for clinical factors , the most predictive laboratory parameters were , in order of significance , levels of creatinine clearance , plasma fibrinogen , and homocysteine . CONCLUSIONS Within two years , folic acid does not seem to reduce clinical end points in patients with stable coronary artery disease ( CAD ) while on statin treatment . Homocysteine might therefore merely be a modifiable marker of disease . Thus , low-dose folic acid supplementation should be treated with reservation , until more trial outcomes become available In a secondary prevention trial conducted by the National Heart , Lung , and Blood Institute , the effect of lipid lowering by drug intervention on the progression of existing coronary artery disease ( CAD ) was evaluated in type II hyperlipidemic patients . This first r and omized , secondary prevention trial compared the effect of cholestyramine and diet with that of placebo and diet in 143 patients over a 5-year period . End points evaluated were progression or regression of CAD , as demonstrated by angiographic changes compared with baseline angiograms . The cholestyramine-treated group demonstrated a significant reduction in total cholesterol and in low-density lipoprotein cholesterol ( LDL ) levels as compared with placebo , and an 8 % increase in high-density lipoprotein cholesterol ( HDL ) . A statistically significant result supporting the use of cholestyramine treatment was found in one category of CAD progression Background : The aim of cardiac rehabilitation ( CR ) is not only physical improvement but also increased quality of life ( QoL ) . A CR programme based upon problem based learning ( PBL ) philosophy was developed , to achieve and apply new knowledge related to coronary artery disease ( CAD ) . The aim of this paper was to evaluate the impact of the PBL programme on QoL. Methods : 207 consecutive patients < 70 years of age with a recent event of CAD were r and omised to a  PBL group ( n = 104 ) or a control group ( n = 103 ) . In addition to st and ard treatment , the PBL patients participated in 13 group sessions during 1 year , where individual learning needs and behavioural changes were focused upon . QoL was measured by the Ladder of Life , Self-Rated Health ( SRH ) , SF 36 , and Cardiac Health Profile ( CHP ) . Results : Significant differences between the groups , favouring the PBL patients , were found by global instruments : more optimistic expectations of the future QoL and a better general condition . No differences were found by SRH , SF 36 or subscales of CHP , but QoL increased in both groups during the year . Conclusions : The main outcome was that QoL improved in both groups with some effects favouring the PBL programme Coronary artery diseases ( CAD ) are main causes of morbidity and hospitalisation in western countries and CAD patients are at considerable risk of suffering further cardiac events . The development and evaluation of secondary prevention programmes therefore an important task . This thesis includes investigations on CAD patients admitted to a secondary prevention programme at Malmö University Hospital , Malmö , Sweden . Four weeks after discharge from the hospital , consecutive male and female patients aged 50 - 70 years with acute myocardial infa rct ion ( AMI ) or treated with coronary artery bypass grafting ( CABG ) surgery  were r and omised to a hospital organised preventive intervention or to usual follow-up at their general practitioners . In the three studies using this r and omised design , 87 ( study II ) , 90 ( study IV ) , and 106 ( study V ) intervention patients were available for evaluation . In addition , without r and omisation , lipid levels at four weeks after the event was compared with levels estimated within 24 hours after onset of symptoms in 141 AMI patients ( study I ) , and quality of life ( QL ) were estimated by question naire at one month and at one year after the event in 266 AMI , 94 CABG , and 16 percutaneous transluminal coronary angioplasty ( PTCA ) patients ( study III ) . The prevention programme was effective in improving food habits but showed no impact on smoking habits or physical exercise in AMI patients ( study II ) . The intervention also did not show any significant improvement in working capacity in AMI and CABG patients . However , working capacity improved in both intervention and reference CABG patients , most probably due to improved coronary circulation from the surgery ( study IV ) . Cholesterol levels decreased significantly in AMI and CABG intervention patients as compared to the corresponding reference patients . This difference most likely was due to a higher frequency of lipid lowering drugs used in the intervention patients ( study V ) . The prevention programme also decreased body mass index significantly in AMI but not in CABG patients ( study V ) . In AMI patients receiving thrombolysis , cholesterol levels estimated within 24 hours after onset of symptoms and at four weeks after the event were virtually equal . In AMI patients not receiving thrombolysis , the lipid estimates from four weeks after the event were slightly , but significantly , above the within 24 hours from onset of symptoms estimates ( study I ) . One month after the event , both somatic and psychological aspects of QL were negatively affected in AMI and CABG patients compared to population controls . One year after the event , patients differed from controls mainly in somatic symptoms ( study III ) . Thus , the intervention programme was most successful in affecting lipid levels and food habits in AMI patients .  QL was considerably affected in patients following an cardiac event , especially during the initial recovery phase . In addition , in patients receiving thrombolysis , cholesterol levels estimated four weeks after an AMI are reasonably valid estimates of baseline values and may be used to decide about lipid lowering interventions BACKGROUND Prediction of hard cardiac events ( myocardial infa rct ion and coronary death ) remains difficult in spite of the identification of several relevant risk factors for the development of coronary artery disease ( CAD ) . New indicators of risk might add to our predictive ability . We used measures of coronary artery calcification ( CAC ) found by electron beam tomography ( EBT ) imaging to develop prediction models for hard cardiac events alone and in association with traditional risk factors for CAD . METHODS Two groups of patients were studied : group A , 676 asymptomatic patients ( mean age 52 years , 51 % men ) prospect ively followed up for 32 + /- 7 months after being referred by primary care physicians for a screening EBT , and group B , 10,122 asymptomatic patients screened by EBT at one center  and used as controls for calculation of calcium score nomograms . RESULTS The occurrence of hard events in group A patients was related to traditional risk factors for CAD , presence of CAC ( score > 0 ) , Ln ( 1 + absolute calcium score [ CS ] ) , and age- and sex-specific CS percentiles ( CS% ) . Univariate analyses showed that age , smoking , diabetes mellitus , presence of CAC , Ln ( 1 + absolute CS ) , and CS% were predictive of hard events ( all P < .05 ) . Multiple logistic regression analyses demonstrated that CS% was the only significant predictor of events and provided incremental prognostic value when added to traditional risk factors for CAD ( chi-square , P < .001 ) . In a comparison of receiver-operator characteristic curves for prediction of hard events , the area under the curve for CS% plus conventional risk factors and age was significantly larger than that obtained by use of traditional risk factors and age separately as predictors ( 0.84 vs 0.71 , respectively , P < .001 ) . Furthermore , the area under the curve of CS% alone was significantly larger than that of traditional risk factors and age combined ( 0.82 vs 0.71 , P = .028 ) . CONCLUSIONS Patients are usually selected for EBT screening on the basis of the presence of conventional risk factors for CAD . However , an age- and sex-specific calcium score provides the best predictive model for the occurrence of hard coronary events and adds incremental prognostic information to conventional risk factors for CAD BACKGROUND Through the processes of oxidation , polymerization , and hydrogenation , the cooking method of frying modifies both foods and their frying medium . However , it remains unknown whether the frequent consumption of fried foods is related to long-term cardiometabolic health . OBJECTIVE We examined fried-food consumption and risk of developing incident type 2 diabetes ( T2D ) or coronary artery disease ( CAD ) . DESIGN Fried-food consumption was assessed by using a question naire in 70,842 women from the Nurses ' Health Study ( 1984 - 2010 ) and 40,789 men from the Health Professionals Follow-Up Study ( 1986 - 2010 ) who were free of diabetes , cardiovascular disease , and cancer at baseline . Time-dependent Cox proportional hazards models were used to estimate RRs and 95 % CIs for T2D and CAD adjusted for demographic , diet , lifestyle , and other cardiometabolic risk factors . Results were pooled by using an inverse variance-weighted r and om-effects meta- analysis . RESULTS We documented 10,323 incident T2D cases and 5778 incident CAD cases .  Multivariate-adjusted RRs ( 95 % CIs ) for individuals who consumed fried foods < 1 , 1 - 3 , 4 - 6 , or ≥7 times/wk were 1.00 ( reference ) , 1.15 ( 0.97 , 1.35 ) , 1.39 ( 1.30 , 1.49 ) , and 1.55 ( 1.32 , 1.83 ) , respectively , for T2D and 1.00 ( reference ) , 1.06 ( 0.98 , 1.15 ) , 1.23 ( 1.14 , 1.33 ) , and 1.21 ( 1.06 , 1.39 ) , respectively , for CAD . Associations were largely attenuated when we further controlled for biennially up date d hypertension , hypercholesterolemia , and body mass index . CONCLUSIONS  Frequent fried-food consumption was significantly associated with risk of incident T2D and moderately with incident CAD , and these associations were largely mediated by body weight and comorbid hypertension and hypercholesterolemia BACKGROUND Dyslipidemia remains underdiagnosed and undertreated in patients with coronary artery disease . The Computer-based Clinical Decision Support System provides an opportunity t close these gaps . OBJECTIVES To study the impact of computerized intervention on secondary prevention of CAD . METHODS The CDSS was programmed to automatically detect patients with CAD and to evaluate the availability of an up date d  lipoprotein profile  and treatment with lipid-lowering drugs . The program produced automatic computer-generated monitoring and treatment recommendations . Adjusted primary clinics were r and omly assigned to intervention ( n=56 ) or st and ard care arms ( n=56 ) . Reminders were mailed to the primary medical teams in the intervention arm every 4 months updating them with current lipid levels and recommendations for further treatment . Compliance and lipid levels were monitored . The study group comprised all patients with CAD who were alive at least 3 months after hospitalization . RESULTS Follow-up was available for 7448 patients ( median 19.8 months , range 6 - 36 months ) . Overall , 51.7 % of patients were adequately screened , and 55.7 % of patients were compliant with treatment to lower lipid level . In patients with initial low density lipoprotein  > 120 mg/dl , a significant decrease in LDL levels was observed in both arms , but was more pronounced in the intervention arm : 121.9 + /- 34.2 vs. 124.3 + /- 34.6 mg/dl ( P < 0.02 ) . A significantly lower rate of cardiac rehospitalizations was documented in patients who were adequately treated with lipid-lowering drugs , 37 % vs. 40.9 % ( P < 0.001 ) . CONCLUSIONS This initial assessment of our data represent a real-world snapshot where physicians and CAD patients often do not adhere to clinical guidelines , presenting a major obstacle to implementing effective secondary prevention . Our automatic computerized reminders system substantially facilitates adherence to guidelines and supports wide-range implementation BACKGROUND A substantial portion of patients with atrial fibrillation ( AF ) also have coronary artery disease ( CAD ) and are at risk for coronary events . Warfarin is known to reduce these events , but increase the risk of bleeding . We assessed the effects of apixaban compared with warfarin in AF patients with and without prior CAD . METHODS AND RESULTS In ARISTOTLE , 18,201 patients with AF were r and omized to apixaban or warfarin .  History of CAD was defined as documented CAD , prior myocardial infa rct ion , and /or history of coronary revascularization . We analyzed baseline characteristics and clinical outcomes of patients with and without prior CAD and compared outcomes by r and omized treatment using Cox models . A total of 6639 ( 36.5 % ) patients had prior CAD . These patients were more often male , more likely to have prior stroke , diabetes , and hypertension , and more often received aspirin  at baseline ( 42.2 % vs. 24.5 % ) . The effects of apixaban were similar among patients with and without prior CAD on reducing stroke or systemic embolism and death from any cause ( hazard ratio [ HR ] 0.95 , 95 % confidence interval [ CI ] 0.71 - 1.27 , P for interaction=0.12 ; HR 0.96 , 95 % CI 0.81 - 1.13 , P for interaction=0.28 ) . Rates of myocardial infa rct ion were numerically lower with apixaban than warfarin among patients with and without prior CAD . The effect of apixaban on reducing major bleeding and intracranial hemorrhage was consistent in patients with and without CAD . CONCLUSIONS In patients with AF , apixaban more often prevented stroke or systemic embolism and death and caused less bleeding than warfarin , regardless of the presence of prior CAD . Given the common occurrence of AF and CAD and the higher rates of cardiovascular events and death , our results indicate that apixaban may be a better treatment option than warfarin for these high-risk patients BACKGROUND Japan EPA Lipid Intervention Study ( JELIS ) was a large-scale clinical trial examining the effects of eicosapentaenoic acid ( EPA ) on coronary artery disease ( CAD ) in hypercholesterolemic patients . Herein , we focused on risk factors other than low-density lipoprotein cholesterol ( LDL-C ) to investigate the effects of EPA on CAD among JELIS primary prevention cases . METHODS Hypercholesterolemic patients on statin therapy but without evidence of CAD ( n=14,981 ) were r and omly assigned to an EPA group ( n=7503 ) or a control group ( n=7478 ) . The relationships between incident CAD , the number of CAD risk factors ( hypercholesterolemia ; obesity ; high triglyceride ( TG ) or low high-density lipoprotein cholesterol ( HDL-C ) ; diabetes ; and hypertension ) and EPA treatment were investigated . RESULTS For the control and EPA groups combined , a higher number of risk factors was directly associated with an increased incidence of CAD . Incidence was lower for the EPA group than for the control group regardless of the numbers of risk factors . Compared to patients with normal serum TG and HDL-C levels , those with abnormal levels ( TG > or=150 mg/dL ; HDL-C < 40 mg/dL ) had significantly higher CAD hazard ratio ( HR : 1.71 ; 95 % CI : 1.11 - 2.64 ; P=0.014 ) . In this higher risk group , EPA treatment suppressed the risk of CAD by 53 % ( HR : 0.47 ; 95 % CI : 0.23 - 0.98 ; P=0.043 ) . CONCLUSIONS Multiple risk factors besides cholesterol are associated with markedly increased incidence of CAD . High TG with low HDL-C represents a particularly potent risk factor . EPA was effective in reducing the incidence of CAD events for patients with this dyslipidemic pattern , suggesting that EPA may be especially beneficial in patients who with abnormal TG and HDL-C levels BACKGROUND Data on the relation between alpha-linolenic acid intake and coronary artery disease ( CAD ) are limited . Other dietary components appear to modify the reported relation between alpha-linolenic acid intake and CAD . OBJECTIVE We examined whether dietary alpha-linolenic acid intake was inversely associated with risk of CAD . DESIGN We prospect ively studied 667 men aged 64 - 84 y from the Zutphen Elderly Study who were free of CAD at baseline .  Dietary intake was assessed by using a cross-check dietary history method . RESULTS During the 10-y follow-up , we documented 98 cases of CAD . After adjustment for age , st and ard coronary risk factors , and intake of trans fatty acids and other nutrients , alpha-linolenic acid intake was not significantly associated with CAD risk . The relative risk of CAD for the highest compared with the lowest tertile of alpha-linolenic acid intake was 1.68 ( 95 % CI : 0.86 , 3.29 ) . alpha-Linolenic acid intake from sources containing trans fatty acids was also nonsignificantly , yet positively , associated with CAD risk .  alpha-Linolenic acid intake from foods that did not contain trans fatty acids was not associated with CAD risk , the relative risk of CAD for the highest compared with the lowest tertile was 1.15 ( 95 % CI : 0.63 , 2.11 ) . CONCLUSION We did not observe a beneficial effect of dietary alpha-linolenic acid intake on the risk of 10-y CAD incidence . Investigating this hypothesis was complicated by the association between intakes of alpha-linolenic acid and trans fatty acids . Given the results of current prospect i ve studies , a protective cardiac effect of alpha-linolenic acid is question able OBJECTIVE To test the efficacy of multifactor intensive intervention for post percutaneous transluminal coronary intervention ( post-PCI ) out patients on self management , risk factor control and outcome . METHODS A total of 263 patients with coronary heart disease ( CAD ) discharged from our cardiac center were r and omized into usual care ( 4 CAD lectures focusing on the 2(nd ) CAD prevention and patients -oriented outpatient visit ) and intensive intervention ( 4 CAD lectures focusing on the 2(nd ) CAD prevention , CAD outpatient visit twice a month , monthly telephone instructions on risk factor control and optimal medication ) . Patients were followed for 12 months and 250 patients completed follow-up . RESULTS There were more patients achieved a LDL-C level of less than 2.6 mmol/L in intensive intervention group than in usual care group ( 71.2 % vs. 48.3 % , P < 0.01 ) . The percentages of patients taking  dietary control  ( 55.3 % vs. 26.2 % , P < 0.01 ) and  physical exercises  ( 64.4 % vs. 39.0 % , P < 0.01 ) , receiving  beta-adrenergic receptor blocker  ( 75.0 % vs. 50.8 % , P < 0.01 ) and  statins  ( 72.0 % vs. 54.2 % , P < 0.01 ) were significantly higher while cardiovascular event rate ( 5.9 % vs. 0 % , P = 0.005)was significantly lower in intensive intervention group than in usual care group . CONCLUSION Multifactor intensive intervention is helpful on improving the second prevention for post-PCI coronary heart disease patients
The m-Health programmes reported positive effects on adherence to medication .
Conclusion Evidence exists that supports the use of e-Health interventions for improving secondary prevention of CAD .
However , a comparison across studies highlighted a wide variability of components and outcomes within the different modes of delivery .
Background Electronic health ( e-Health ) interventions are emerging as an effective alternative model for improving secondary prevention of coronary artery disease ( CAD ) .
The aim of this study was to describe the effectiveness of different modes of delivery and components in e-Health secondary prevention programmes on adherence to treatment , modifiable CAD risk factors and psychosocial outcomes for patients with CAD .