How well are we doing in secondary prevention after myocardial infarction - The STABILITY study experience

Background: Compliance with preventive medications after myocardial infarction is known to be suboptimal in New Zealand (NZ), and to worsen over time. Patients who participate in clinical trials may have better compliance and risk factor control. This study describes achievement of standard of care goals in NZ participants compared to those from the rest of the world in the global STABILITY study. This study evaluated the effects of darapladib on top of best care on cardiovascular death, MI and stroke in high risk patients with established cardiovascular disease. Methods: Achievement of standard of care targets was compared for the 202 New Zealand participants with 15,828 participants from 39 countries worldwide. Medication adherence and cardio-metabolic risk factors were measured at baseline and study end. Regular feedback on achievement of standard of care goals was provided to study investigators during the study. Results: For NZ and the rest of the world respectively aspirin (97.1% vs. 93.4%) and statin use (96.5% vs. 97.6%) were high at baseline. NZers were less likely to have reached target LDL-cholesterol of <1.8mmo/l (32.4% vs. 39.1%) or HbA1c <7% if diabetic (20.8% vs.33.9%). However, by study end more NZ patients compared to those from the rest of the world were at target LDL-c <1.8mmolo/l (54.1% vs. 41.3%), and HbA1c <7% (34.5% vs. 31.3%). Similarly, New Zealand patients compared to the rest of the world were less likely to have achieved a target systolic blood pressure < 140 mmHg at baseline (65.8% vs. 75.3%), but this also improved by study end (70.2% vs. 74.2%) Conclusion: In the STABILITY study NZ participants were less likely to achieve secondary prevention targets than the rest of the world at study entry, but treatment goals improved during follow-up. These observations suggest clear treatment targets and regular review may improve secondary prevention of cardiovascular disease. CSANZ NZ AbstractsHeart, Lung and CirculationVol. 23Preview Full-Text PDF