Recurrence of acute coronary syndrome during inadeguate control of cardiovascular risk factors

It is recognized that inadeguate control of cardiovascular risk factors is involved in the onset and progression of atherosclerotic diseases. In particular, data indicate that inadequate reduction of total cholesterolemia, LDL and HDL values, achieved by pharmacological and non pharmacological methods, implicates a raised risk of new events. By contrast, it is not clearly acknowledged the role played by other risk factors, as Apolipoprotein A, Apolipoprotein B, Apolipoprotein B/A1 ratio and Lipoprotein (a).Methods: We analyzed data from 539 consecutively recruited subjects affected by Acute Coronary Syndrome (STEMI, NSTEMI, Unstable Angina) confirmed by critical obstructive lesions at Coronary Angiography. The patients, admitted at our Coronary Care Unit (CCU), were divided in two groups: Group 1(first event), Group 2 (recurrence). Results: In our population an ischaemic recurrent event was more frequently NSTEMI (59% vs 28%) or Unstable Angina (14% vs 7%), rather than STEMI and it was more common in the elderly (69 yrs vs 63 yrs), in overweight patients, in hypertensives (88% vs 57%) and in diabetics (38% vs 27%) Addictionally, patients of Group 2 vs Group 1 presented an insufficient control of dyslipidemia, with not optimal level of total cholesterol (159 vs 185 mg/dl), LDL cholesterol (99 vs 122mg/dl), apolipoprotein B (93 vs 108 ng/dl), Lipoprotein (a) (41 vs 30 mg/dl) and Apolipoprotein B/A1 ratio (0,86 vs 0,97). Patients of Group 1 were often naive from a therapeutical point of view, not taking any medications for hypertension, dyslipidemia and therefore they had very often an even worse control of risk factors rather than Group 2. Surprisingly we noticed that 40% of patients of Group 2 were not compliant to hypolipidemic therapy, thus resulting in LDL cholesterol level not at target following international Guidelines (<70 mg/dl) in most of them (77%). Addictionally,Group 2 subjects had more frequently a multi-vessel coronary artery disease (75% vs 55%)and a reduced renal function (GFR: 73 ml/min vs 84 ml/min). Conclusion: Therefore, our data suggest that in Coronary Artery Disease risk factors control result suboptimal both in primary and in secondary prevention.