Statins for those who need them . . . and other storiesBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j963 (Published 02 March 2017) Cite this as: BMJ 2017;356:j963
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Re: Risk factors stay high after coronary events: nurse led clinics can help improve secondary prevention
Minerva observed that the majority of patients with coronary heart disease in a recent Norwegian survey failed to achieve the targets for secondary prevention. The study indicates that the intervention was led and monitored in secondary care with no input from GPs. The authors express concern that secondary prevention of coronary heart disease is failing in a developed country and make a plea for ‘knowledge about factors associated with poor risk factor control and strategies for implementation of these factors’.
Nurse led clinics in primary care coupled with good communication between hospital and primary care to ensure improved uptake of cardiac rehabilitation have been instrumental in improving the secondary prevention of coronary heart disease in the UK.  A recently reported community-based nurse-led prevention programme from London also reported improvements in the Mediterranean diet scores, levels of fitness /physical activity with significant increases in proportions achieving their blood pressure and low-density lipoprotein cholesterol targets. This study also demonstrated improvements in patient reported outcomes of depression and health related quality of life.
Involving nurses and other health care professionals from cardiac rehabilitation across primary and secondary care services can help to integrate the provision of secondary prevention in coronary heart disease. Minerva is quite right to state that 'secondary prevention of cardiovascular disease isn't just about prescribing statins'. Healthy life-style interventions can substantially reduce further cardiovascular events and improve the patient's quality of life.
1. Minerva. Risk factors stay high after coronary events http://www.bmj.com/content/bmj/356/bmj.j963.full.pdf
2. Sverre et al. Unfavourable risk factor control after coronary events in routine clinical practice BMC Cardiovascular Disorders (2017) 17:40 DOI 10.1186/s12872-016-0387-z
3. Dalal, HM; Wingham, J; Taylor, RS. Acute coronary syndromes: key role of rehabilitation and primary care in long term secondary prevention. BMJ 2015; 351:h6350
4. Conolly S, Wood D, Jones J et al. Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme. Heart 2017 10.1136/heartjnl-2016-310477
Competing interests: No competing interests