Impact of primary and secondary prevention on morbidity and mortality of ischemic cardiopathy

: Coronary artery disease (CAD) is the major cause of death in most developed countries and in many developing countries like Mexico. Epidemiologic studies initiated in the middle of the last century found that hypercholesterolemia, hypertension, tobacco smoking, diabetes mellitus, and other conditions are important precursors of atherosclerosis. With this knowledge, prevention of CAD was started. Some countries implemented a population strategy aimed at improving health-oriented behavior, mainly nutrition, smoking, and physical exercise in the entire population. The favorable changes in risk factors and better medical treatment for CAD patients have resulted in decreased coronary mortality over the past three decades. Randomized trials of antihypertensive treatment have shown that reduction of blood pressure leads to a decreased incidence of stroke and coronary events. Similarly, large secondary and primary prevention clinical trials of statin therapy have conclusively demonstrated the benefit of cholesterol lowering in preventing coronary morbidity and mortality. Despite this large body of scientific evidence, surveys in different countries show that in the population at large and particularly, in patients with documented CAD, preventive medical therapies are underutilized and, as a consequence, many patients are not achieving the recommended goals. Measures that increase compliance by both clinicians and patients to regimens with proven benefits are urgently required.