Changing Lifestyle Habits as Secondary Prophylaxis after Coronary Artery Bypass Grafting
Background: Many studies have investigated the effect on mortality and morbidity of modified risk factors after coronary artery bypass grafting (CABG). We performed a retrospective survey to evaluate changing lifestyle habits after CABG during 1990-2003, focusing on the correlation between lifestyle habits and freedom from symptoms and regained exercise tolerances.
Methods: We reviewed data from 2269 patients who had undergone CABG in the year 1990, 1993, 1998, 2000, 2001, 2002, or 2003. Data were collected with a questionnaire that addressed lifestyle modifications and their outcomes with regard to quality of life for up to 5 years after surgery.
Results: We observed significant decreases in changing dietary habits after surgery in patients who had surgery in 2000-2003 compared with patients who had surgery in 1990-1998 (15.9% ± 1.6% vs 24.7% ± 2.6%; P < .001). In addition, the desire for nutritional counselling decreased steadily over time (35.1% ± 7.9% vs 26.6% ± 1.4%; P <.0001). Notably, among patients 50-59 years old, fewer men than women followed a strict diet (males 20.0% vs females 41.5%; P = .001). Patients suffering from recurrent angina consulted nutritionists more often than patients without angina (36.6% vs 29.8%; P = .016). The more the patients were restricted in terms of physical fitness, as determined by the New York Heart Association (NYHA) class, the more likely they were to adhere to a healthy diet (NYHA III 22.2% vs NYHA II 14.6% vs NYHA I 10.2%; P <.001). Among patients 60-79 years old, men exercised more often than women (72.4% ± 2.4% vs 51.1% ± 4.9%; P <.001) and suffered less frequently from recurrent angina (13.4% ± 4.0% vs 28.8% ± 10.8%; P = .002).
Conclusions: Despite knowledge of hypercholesterolemia or obesity as agents contributing to advancing coronary heart disease, attention to nutrition tends to significantly decrease over time in patients who have undergone CABG. Thus patients who have undergone CABG, especially male patients older than 50, years would benefit from dietary education. Similarly, female patients older than 60 years would benefit from increased physical activity. Patients obviously tend to delay lifestyle modification until symptoms occur. Hence they must be reminded of the importance of healthy nutrition and adequate physical activity.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. 1999. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99:779-85.nde Lorgeril M, Salen P. 2006. The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutr 9:118-23.nDi Cecco R, Patel U, Upshur RE. 2002. Is there a clinically significant gender bias in post-myocardial infarction pharmacological management in the older (<60) population of a primary care practice? BMC Fam Pract 3:8.nDishman RK, Ickes W. 1981. Self-motivation and adherence to therapeutic exercise. J Behav Med 4:421-38.nEuropean Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE). 1997. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. EUROASPIRE Study Group. European Action on Secondary Prevention through Intervention to Reduce Events. Eur Heart J 18:1569-82.nEUROASPIRE II. 2001. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J 22:554-72.nGoldman S, Copeland J, Moritz T, et al. 1989. Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy: results of a Veterans Administration Cooperative Study. Circulation 80:1190-7.nIestra J, Knoops K, Kromhout D, de Groot L, Grobbee D, van Staveren W. 2006. Lifestyle, Mediterranean diet and survival in European post-myocardial infarction patients. Eur J Cardiovasc Prev Rehabil 13:894-900.nKnatterud GL, Rosenberg Y, Campeau L, et al. 2000. Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Post CABG Investigators. Circulation 102:157-65.nLieberman L, Meana M, Stewart D. 1998. Cardiac rehabilitation: gender differences in factors influencing participation. J Womens Health 7:717-23.nMead A, Atkinson G, Albin D, et al. 2006. Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease - evidence from systematic reviews of randomized controlled trials (second update, January 2006). J Hum Nutr Diet 19:401-19.nO'Connor GT, Buring JE, Yusuf S, et al. 1989. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80:234-44.nPravastatin Multinational Study Group for Cardiac Risk Patients. 1993. Effects of pravastatin in patients with serum total cholesterol levels from 5.2 to 7.8 mmol/liter (200 to 300 mg/dl) plus two additional atherosclerotic risk factors. Am J Cardiol 72:1031-7.nScandinavian Simvastatin Survival Study. 1994. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344:1383-9.nvan Domburg RT, Meeter K, van Berkel DF, Veldkamp RF, van Herwerden LA, Bogers AJ. 2000. Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 36:878-83.nWood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyorala K. 1998. Prevention of coronary heart disease in clinical practice: summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. J Hypertens 16:1407-14.nBowker TJ, Clayton TC, Ingham J, et al. 1996. A British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events). Heart 75:334-42.nBurt A, Thornley P, Illingworth D, White P, Shaw TR, Turner R. 1974. Stopping smoking after myocardial infarction. Lancet 1:304-6.nPyorala K, De Backer G, Graham I, Poole-Wilson P, Wood D. 1994. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Atherosclerosis 110:121-61.nSacks FM, Pfeffer MA, Moye LA, et al. 1996. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 335:1001-9.n
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