Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes
Abstract
Background— Although preventive drug therapy is a priority after acute coronary syndrome, less is known about adherence to behavioral recommendations. The aim of this study was to examine the influence of adherence to behavioral recommendations in the short term on risk of cardiovascular events. Methods and Results— The study population included 18 809 patients from 41 countries enrolled in the Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5 randomized clinical trial. At the 30-day follow-up, patients reported adherence to diet, physical activity, and smoking cessation. Cardiovascular events (myocardial infarction, stroke, cardiovascular death) and all-cause mortality were documented to 6 months. About one third of smokers persisted in smoking. Adherence to neither diet nor exercise recommendations was reported by 28.5%, adherence to either diet or exercise by 41.6%, and adherence to both by 29.9%. In contrast, 96.1% of subjects reported antiplatelet use, 78.9% reported statin use, and 72.4% reported angiotensin-converting enzyme/angiotensin receptor blocker use. Quitting smoking was associated with a decreased risk of myocardial infarction compared with persistent smoking (odds ratio, 0.57; 95% confidence interval, 0.36 to 0.89). Diet and exercise adherence was associated with a decreased risk of myocardial infarction compared with nonadherence (odds ratio, 0.52; 95% confidence interval, 0.4 to 0.69). Patients who reported persistent smoking and nonadherence to diet and exercise had a 3.8-fold (95% confidence interval, 2.5 to 5.9) increased risk of myocardial infarction/stroke/death compared with never smokers who modified diet and exercise. Conclusions— Adherence to behavioral advice (diet, exercise, and smoking cessation) after acute coronary syndrome was associated with a substantially lower risk of recurrent cardiovascular events. These findings suggest that behavioral modification should be given priority similar to other preventive medications immediately after acute coronary syndrome. Clinical Trial Registration Information— URL: http://clinicaltrials.gov/ct2/show/NCT00139815. Unique identifier: NCT00139815.
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The risk is rapidly reduced after cessation, with significant morbidity reductions reported within the first 6 months.
“The risk is rapidly reduced after cessation, with significant morbidity reductions reported within the first 6 months.250”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [250]
Preventive treatment tends to be abandoned within 6 months of hospital discharge after myocardial infarction, PCI, or CABG.
“which has a tendency to be abandoned within 6 months of hospital discharge after myocardial infarction, PCI, or CABG.250”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [250]
The approach of the cardiologist reviewing discharge recommendations and helping the patient comply has a significant impact on mid-term prognosis.
“This approach has a significant impact on mid-term prognosis.250,437”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [250]
Adherence to behavioural advice on diet, exercise, and smoking cessation after ACS was associated with a substantially lower risk of recurrent cardiovascular events compared with non-adherence.
“Adherence to behavioural advice (diet, exercise, and smoking cessation) after an ACS was associated with a substantially lower risk of recurrent cardiovascular events compared with non-adherence.250”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [250]
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Cites
Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., McQueen, M., Budaj, A., Pais, P., Varigos, J., et al. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17018-9 · Cited by 12,026 · see citing works
Self-citationTaylor, R. S., Brown, A., Ebrahim, S., Jolliffe, J., Noorani, H., Rees, K., Skidmore, B., Stone, J. A., Thompson, D. R., & Oldridge, N. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2004.01.009 · Cited by 2,239 · see citing works
Marchioli, R., Barzi, F., Bomba, E., Chieffo, C., Di Gregorio, D., Di Mascio, R., Franzosi, M. G., Geraci, E., Levantesi, G., Maggioni, A. P., et al. (2002) · Circulation · doi:10.1161/01.cir.0000014682.14181.f2 · Cited by 1,311 · see citing works
Mente, A., de Koning, L., Shannon, H. S., & Anand, S. S. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.38 · Cited by 1,267 · see citing works
Self-citationComparison of Fondaparinux and Enoxaparin in Acute Coronary Syndromes
(2006) · New England Journal of Medicine · doi:10.1056/nejmoa055443 · Cited by 1,228 · see citing works
The Coronary Drug Project Research Group (1980) · New England Journal of Medicine · doi:10.1056/nejm198010303031804 · Cited by 659 · see citing works
Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome
Pell, J. P., Haw, S., Cobbe, S., Newby, D. E., Pell, A. C. H., Fischbacher, C., McConnachie, A., Pringle, S., Murdoch, D., Dunn, F., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmsa0706740 · Cited by 446 · see citing works
Giannuzzi, P. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.20.2194 · Cited by 411 · see citing works
Twenty-Year Trends in Coronary Risk Factors in North Karelia and in Other Areas of Finland
Vartiainen, E. A., Puska, P., Jousilahti, P., KORHONEN, H. J., Tuomilehto, J. O., & Nissinen, A. M. (1994) · International Journal of Epidemiology · doi:10.1093/ije/23.3.495 · Cited by 271 · see citing works
Mediterranean diet and survival among patients with coronary heart disease in Greece
Trichopoulou, A., Bamia, C., & Trichopoulos, D. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.8.929 · Cited by 266 · see citing works
Zatoński, W. A., McMichael, A. J., & Powles, J. W. (1998) · BMJ · doi:10.1136/bmj.316.7137.1047 · Cited by 236 · see citing works
Smoking Status and Risk for Recurrent Coronary Events after Myocardial Infarction
Rea, T. D., Heckbert, S. R., Kaplan, R. C., Smith, N. L., Lemaitre, R. N., & Psaty, B. M. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-137-6-200209170-00009 · Cited by 213 · see citing works
Goldenberg, I. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.19.2301 · Cited by 178 · see citing works
Chow, C. K., Lock, K., Teo, K., Subramanian, S., McKee, M., & Yusuf, S. (2009) · International Journal of Epidemiology · doi:10.1093/ije/dyn258 · Cited by 160 · see citing works
Self-citationTwardella, D., Küpper-Nybelen, J., Rothenbacher, D., Hahmann, H., Wüsten, B., & Brenner, H. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.08.017 · Cited by 62 · see citing works
Menotti, A., Lanti, M., Kromhout, D., Blackburn, H., Nissinen, A., Dontas, A., Kafatos, A., Nedeljkovic, S., & Adachi, H. (2007) · European Journal of Epidemiology · doi:10.1007/s10654-007-9176-4 · Cited by 61 · see citing works
MICHELANGELO OASIS 5 Steering Committee (2005) · American Heart Journal · doi:10.1016/j.ahj.2005.09.025 · Cited by 51 · see citing works
Antiarrhythmic Mechanisms of n-3 PUFA and the Results of the GISSI-Prevenzione Trial
Marchioli, R., Levantesi, G., Macchia, A., Maggioni, A. P., Marfisi, R. M., Silletta, M. G., Tavazzi, L., Tognoni, G., & Valagussa, F. (2005) · The Journal of Membrane Biology · doi:10.1007/s00232-005-0788-x · Cited by 40 · see citing works
Panagiotakos, D. B., Pitsavos, C. E., Stefanadis, C., & for the GREECS Study Investigators (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000221863.42286.1e · Cited by 13 · see citing works
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Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehx393 · Cited by 9,728 · see citing works
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes
Knuuti, J., Wijns, W., Saraste, A., Capodanno, D., Barbato, E., Funck-Brentano, C., Prescott, E., Storey, R. F., Deaton, C., Cuisset, T., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehz425 · Cited by 7,166 · see citing works
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457 · see citing works
Collet, J.-P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa575 · Cited by 5,037 · see citing works
Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., et al. (2019) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2019.08.014 · Cited by 4,854 · see citing works
Libby, P., Buring, J. E., Badimon, L., Hansson, G. K., Deanfield, J., Bittencourt, M. S., Tokgözoğlu, L., & Lewis, E. F. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0106-z · Cited by 3,211 · see citing works
Lawler, P. R., Filion, K. B., & Eisenberg, M. J. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.07.017 · Cited by 701 · see citing works
Chow, C. K., Redfern, J., Hillis, G. S., Thakkar, J., Santo, K., Hackett, M. L., Jan, S., Graves, N., de Keizer, L., Barry, T., et al. (2015) · JAMA · doi:10.1001/jama.2015.10945 · Cited by 676 · see citing works
Self-citationTeo, K., Lear, S., Islam, S., Mony, P., Dehghan, M., Li, W., Rosengren, A., Lopez-Jaramillo, P., Diaz, R., Oliveira, G., et al. (2013) · JAMA · doi:10.1001/jama.2013.3519 · Cited by 305 · see citing works
Self-citationHaykowsky, M., Scott, J., Esch, B., Schopflocher, D., Myers, J., Paterson, I., Warburton, D., Jones, L., & Clark, A. M. (2011) · Trials · doi:10.1186/1745-6215-12-92 · Cited by 228 · see citing works
Vita, J. A. (2011) · Circulation · doi:10.1161/circulationaha.111.078824 · Cited by 195 · see citing works
F. Piepoli, M. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9583-6 · Cited by 162 · see citing works
Bauer, L. K., Caro, M. A., Beach, S. R., Mastromauro, C. A., Lenihan, E., Januzzi, J. L., & Huffman, J. C. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.12.017 · Cited by 162 · see citing works
Beishuizen, C. R., Stephan, B. C., van Gool, W. A., Brayne, C., Peters, R. J., Andrieu, S., Kivipelto, M., Soininen, H., Busschers, W. B., Moll van Charante, E. P., et al. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5218 · Cited by 128 · see citing works
Huffman, J. C., Millstein, R. A., Mastromauro, C. A., Moore, S. V., Celano, C. M., Bedoya, C. A., Suarez, L., Boehm, J. K., & Januzzi, J. L. (2016) · Journal of Happiness Studies · doi:10.1007/s10902-015-9681-1 · Cited by 102 · see citing works
Redfern, J., Coorey, G., Mulley, J., Scaria, A., Neubeck, L., Hafiz, N., Pitt, C., Weir, K., Forbes, J., Parker, S., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-00325-z · Cited by 95 · see citing works
Self-citationFrey, P., Waters, D. D., DeMicco, D. A., Breazna, A., Samuels, L., Pipe, A., Wun, C.-C., & Benowitz, N. L. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2010.09.006 · Cited by 64 · see citing works
Lifestyle modification in secondary prevention
Piepoli, M. F., & Villani, G. Q. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317703828 · Cited by 33 · see citing works
Ethnic Minorities’ Experiences of Cardiac Rehabilitation: A Scoping Review
Carew Tofani, A., Taylor, E., Pritchard, I., Jackson, J., Xu, A., & Kotera, Y. (2023) · Healthcare · doi:10.3390/healthcare11050757 · Cited by 16 · see citing works
Heart rate dynamics after exercise in cardiac patients with and without type 2 diabetes
Neves, V. (2011) · Frontiers in Physiology · doi:10.3389/fphys.2011.00057 · Cited by 14 · see citing works
- Authors
- Chow, C. K., Jolly, S., Rao-Melacini, P., Fox, K. A. A., Anand, S. S., & Yusuf, S.
- Affiliations
- The University of Sydney (AU)
- From the Population Health Research Institute (C.K.C., S.J., P.R.-M., S.S.A., S.Y.) and Departments of Medicine (C.K.C., S.S.A., S.Y.) and Epidemiology (S.S.A.), McMaster University, and Hamilton Health Sciences (C.K.C., S.J., P.R.-M., S.S.A., S.Y.), Hamilton, Ontario, Canada; The George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia (C.K.C.); and Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United...
- Venue
- Circulation
- Published
- 2010-02-16
- Volume
- 121
- Issue
- 6
- Pages
- 750-758
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2155243998
- Cited by
- 719
- References
- 19
- Citations by year
- 2026: 13 · 2025: 26 · 2024: 41 · 2023: 36 · 2022: 47 · 2021: 47 · 2020: 48 · 2019: 53 · 2018: 40 · 2017: 53 · 2016: 53 · 2015: 61 · 2014: 43 · 2013: 42 · 2012: 55
- FWCI
- 34.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- acute coronary syndrome, behavior change, smoking cessation, dietary adherence, physical activity, cardiovascular events, myocardial infarction, stroke, all-cause mortality, secondary prevention, antiplatelet therapy, statins, ACE inhibitors, angiotensin receptor blockers
- MeSH terms
- Adult, Aged, Aged, 80 and over, Feeding Behavior, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Myocardial Infarction, Patient Compliance, Risk Factors, Socioeconomic Factors, Health Behavior, Exercise, Randomized Controlled Trials as Topic, Smoking Cessation, Stroke, Acute Coronary Syndrome
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