On the issue of residual risk in patients with myocardial infarction

On the issue of residual risk in patients with myocardial infarction

V.V. Kashtalap, D.Yu. Sedykh

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 

Aim: to examine differences in baseline clinical anamnestic, behavioral, and socioeconomic characteristics of patients, as well as clinical effects of an original optimized secondary prevention program for myocardial infarction (MI) depending on implementation of 1-year residual cardiovascular risk (CVR).

Materials and Methods: the study included 75 patients with MI who underwent a mandatory cardiological follow-up within one year and demonstrated adequate adherence to components of prognostic therapy (at least 75%), as well as to training within a framework of the original comprehensive CVR management program which included targeted secondary prevention information (phone callings and material distribution via the informative and preventive Telegram channel). Data on the medical history, clinical course of MI, and inpatient management were collected from all patients, and socioeconomic indicators and behavioral risk factors were assessed. Within one year after MI, endpoints comprising residual CVR, as well as achievement of target values ​​(LDL cholesterol level: <1.4 mmol/L, blood pressure: <130/80 mmHg, resting heart rate: 55–60 beats per minute), and modification of behavioral risk factors (if any) including dietary changes, were reported. Then, a comparative analysis of the collected variables was carried out in patient groups depending on implementation of residual CVR.

Results: 6.7% of patients with MI have residual CVR representing annual adverse outcomes (death, emergency hospitalization due to unstable angina) Distinctive characteristics of patients with residual CVR include: a protein-carbohydrate dietary pattern during a year prior to MI, anterior MI location, in-hospital loop diuretic therapy for MI, a lower rate of achieving target blood pressure in one year after the index event, insufficient minimization of monthly stress and a trend to increase total weekly physical activity, as well as a lower trend to modify dietary components.

Conclusion: regardless of adequate prognosis-improving therapy, cardiological monitoring, and secondary prevention training, patients with a history of MI have a CVR. Behavioral factors, clinical features of MI and its treatment, and incomplete implementation of positive clinical effects of annual secondary prevention instruction characterize patients with residual CVR, and this should be considered to optimize management.

Keywords: ischemic heart disease, myocardial infarction, prognosis, residual risk factors, dyslipidemia.

For citation: Kashtalap V.V., Sedykh D.Yu. On the issue of residual risk in patients with myocardial infarction. RMJ. 2025;8:8–13. DOI: 10.32364/2225-2282-2025-8-2