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Ann Thorac Surg 1995;60:1
© 1995 The Society of Thoracic Surgeons

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Editorial

Secondary Prevention of Atherosclerosis: Emphasizing Risk Factor Management to Patients

Cardiovascular & Thoracic Surgeons, Inc, Cincinnati, Ohio

Coronary artery bypass grafting clearly improves survival and improves quality of life for patients with extensive coronary artery disease [1, 2]. With time, however, an increasing number of patients experience progression of atherosclerosis in native arteries as well as their bypass grafts, leading to further morbidity and mortality as well as the need for additional invasive procedures [1].

A number of patient risk factors are known to increase the likelihood of progression of atherosclerosis. A recent statement from the American Heart Association entitled ``Optimal Risk Factor Management in the Patient After Coronary Revascularization'' [3] and the publication of the Scandinavian Simvastatin Survival Study [4] underscore the importance of measures that have been demonstrated to reduce the progression of atherosclerosis in patients who have documented coronary artery disease.

Surgeons do not necessarily follow up patients for an extended period of time after coronary artery bypass grafting. Nonetheless, surgeons are in an excellent position to introduce and strongly recommend risk factor management programs to patients and their significant others. Patients may be more receptive to such concepts around the time of a major surgical procedure, when there is at least a temporary disruption in normal lifestyles, rather than later when they are feeling well and have returned to many of the environmental and social circumstances that may have contributed to their atherosclerotic disease.

Over the next few years, the American Heart Association will be stressing the importance of secondary prevention programs for patients who have undergone coronary revascularization procedures. Representatives of the American Heart Association's Council on Cardio-Thoracic and Vascular Surgery, and the Task Force on Cholesterol Issues have met with the leadership of The Society of Thoracic Surgeons, who have agreed that secondary prevention is an important topic for surgeons to emphasize to their patients.

Specific risk factors and goals of therapy are noted in Table 1. A fasting lipid profile should be obtained 8 to 12 weeks after surgical revascularization. Education of patients and families by the surgeon or the surgeon's designate (eg, nurse, physician's assistant) regarding specific goals of therapy, including target lipid fraction levels, can stress the importance of achieving such goals. In addition, communication of the same goals to primary care referring physicians may reinforce further the importance of secondary prevention principles to those who will largely be responsible for long-term management.

Footnotes

Address reprint requests to Dr Hiratzka, Cardiovascular & Thoracic Surgeons, Inc, 2123 Auburn Ave, #401, Cincinnati, OH 45219.

References

1. Kirklin JW, Akins CW, Blackstone EH, et al. ACC/AHA Task Force report: guidelines and indications for coronary artery bypass graft surgery. J Am Coll Cardiol 1991;17:543–89.[Medline]
2. Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994;344:563–70.[Medline]
3. Pearson T, Rapaport E, Criqui M, et al. Optimal risk factor management in the patient after coronary revascularization: a statement for healthcare professionals from an American Heart Association writing group. Circulation 1994;90:3125–33.[Free Full Text]
4. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383–9.[Medline]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Loren F. Hiratzka Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hiratzka, L. F. Search for Related Content PubMed PubMed Citation Articles by Hiratzka, L. F.