Study Estimates Event-Free Years Gained with Optimal Management After Heart Attack

Tinka van Trier, MD

Data from a pooled cohort study performed by investigators at the Amsterdam University Medical Centre suggests adherence to sound lifestyle advice and medication could prolong a patient’s healthy years of life by more than 7 years following a heart attack.

Using data from 6 prospective studies with more than 3200 patients, investigators determined residual lifetime risk of major adverse cardiovascular events could decrease from 54% to 21%, if optimally treated, which translated to a median increase of 7.5 event-free years of life in a simulation model.

“The findings show that despite current efforts to reduce the likelihood of new events after a heart attack, there is considerable room for improvement,” said study author Tinka van Trier, MD, of Amsterdam University Medical Centre, the Netherlands, in a statement. Our analysis suggests that the risk of another cardiovascular event could, on average, be halved if therapies were applied or intensified. For individual patients, this would translate into gaining an average of 7.5 event-free years.”

Presented at the European Society of Cardiology (ESC) Congress 2021, the study was performed by van Trier and colleagues from multiple Netherlands-based institutions with the goal of quantifying the impact of addressing modifiable risk factors and optimal medication adherence on residual risk in a secondary prevention cohort. To do so, investigators designed their study as a pooled cohort analysis of patients from the Response 1 and 2, Opticare, EuroAspire IV and V, and HELIUS studies, which resulted in the identification of a cohort of 3230 patients.

The study cohort had a mean age of 61±8 years, a median follow-up of 1.1 (IQR, 1.0-1.8 years, after index acute coronary syndrome or revascularization, and was 24% women. The outcomes of interest for the analysis were the percent reduction in individual lifetime risk for myocardial infarction, stroke, or cardiovascular death using the SMART-REACH model and event-free years gained by change from current treatment to a simulated guideline-directed optimal situation.

Of the 3230 patients included in the study, just 7% met all life-style related risk targets at follow-up. In contrast, 10% of patients met none of the lifestyle-related risk targets at follow-up. Investigators pointed out 30% of the cohort continued smoking, 79% had a BMI of 25 kg/m2 or greater, and 45% reported insufficient physical activity. Additionally, 40% had a systolic blood pressure of 140 mmHg or greater, 65% had an LDL-C above target, and 40% of those considered overweight met the criteria for obesity. Investigators did note use of preventive medications was common. Specifically, 87% were using antithrombotic agents, 85% were using lipid-lowering medications, and 86% reported use of blood pressure-lowering medications.

Upon analysis, investigators determined residual lifetime risk for cardiovascular events and cardiovascular death would decrease from a mean of 54±11% to 25±1-0% if patients adhered to optimal guideline-directed treatment. Additionally, the results indicated the median event-free years of life gained would be 7.4 (IQR, 5.2-10.6) years.

“Most heart attack patients remain at high risk of a second attack one year later,” Van Trier added. “Our study suggests that improving both lifestyles and medication use could lower this risk, with a gain in many years of life without a cardiovascular event.”

This study, “Modifiable lifetime risk for recurrent major cardiovascular events: observations in a contemporary pooled cohort,” was presented at ESC Congress 2021.