Object - risk profile in patients (pts) after myocardial infarction (MI). Aim - to improve secondary prevention in pts after MI on base of assessment of prevalence and control of main risk factors (RF) in patients (pts) after myocardial infarction (MI), detection of influence of social and demographical determinants on it, ascertaining of independent predictors of poor prognosis due to data of 5-years prospective observation. Newnees - it was found that the most prevalent RF in pts after MI are arterial hypertension, hypercholesterolemia, obesity, and the least - diabetes mellitus (DM); prevalence of arterial hypertension, hypercholesterolemia, DM, obesity, abdominal obesity and multiply RF was higher in women vs men; prevalence and control of most of RF depended from such social and demographical determinants as age, sex, family support, marital status, education level; secondary prevention is poor as only every fifth patient reached recommended goals of blood pressure, plasma glucose, total cholesterol, every fourth patient with obesity and abdominal obesity tried to lost flesh. Only half of pts use beta-blockers, ACE, aspirin, every tenth - use statins; it was demonstrated that sixth part of pts didn't take any medications after MI; adherence was assessed and the main reasons of non-adherence were identified - side effects of drugs and misunderstanding of necessary to use recommended drugs for long term; quality of secondary prevention depended on doctors speciality: pts who attend cardiologists vs therapeutists/family doctors or neurologists more frequently use beta-blockers, statins, aspirin, have lower levels of systolic BP, heart rate, total cholesterol, LDL cholesterol; age, smoking and beta-blockers non-using were found as factors independently associated with combined CV endpoint and independent predicrors of CVdeath became age, DM, smoking. Results - the most prevalent RFs are arterial hypertension, hypercholesterolemia, obesity, and the least - diabetes mellitus (DM). Prevalence of AH is 84,1%, obesity - 58,0%, DM - 13,8%, hypercholesterolemia - 55,4%, smoking - 18,3%, hypodynamia - 21,6%. More than a half of pts (61,9%) have multiply (three and more) RFs. Secondary prevention is poor as recommended goals of blood pressure reach only 20,4% of pts with AH, plasma glucose levels - 20,6%, total cholesterol levels - 23,8% and 26,7% pts with obesity and abdominal obesity tried to lost flesh. Only half of pts use beta-blockers (49,8%), ACE (52,6%), aspirin (51,1%), every tenth - use statins (10,5%). The sixth part of pts (15,6%) doesn't take any medications after MI. Age (р<0,001, HR=3,3), smoking (р=0,01, HR=1,7) and beta-blockers non-using (р=0,048, HR=1,4) were found as factors independently associated with combined CV endpoint. Reasonable ways to optimize secondary prevention were found in pts after MI on a base of assessment of prevalence and RF control, their relationship with medical and social determinants, analysis of the effectiveness of drug treatment, adherence to it, evaluating of the quality of medical obsevation and identifying of major predictors of poor CV prognosis. Results were implemented in practice of a number medical institutions. The field is medicine.
