A 45-year-old woman presented to our institution for cardiovascular risk assessment. The patient had no personal or family history of cardiovascular disease (CVD), but reported smoking 1 pack of cigarettes daily. She noted exercising occasionally without symptomatic limitations.
The last 2 decades have seen enormous strides in the identifi cation and modification of cardiovascular disease (CVD) risk factors. Many large, population-based studies, led by the Framingham Heart Study, have been invaluable in identifying these risk factors.
While reviewing the American Heart Association (AHA) 2008 Clinical Perspectives in the January 2009 issue of Cardiology Review, especially the article by Dr Ferdinand regarding African American beliefs and adherence to antihypertensive medications, it dawned upon me that a review of articles and data on hypertension in Asian Indians is also warranted, as this population is often overlooked.
Nonadherence to beta blockers, statins, or angiotensin-converting enzyme inhibitors is common (21%-29%) among patients with coronary artery disease (CAD). Patients who do not adhere to their medication regimens are at increased risk of mortality, cardiovascular hospitalizations, and revascularization procedures; thus, medication nonadherence should be a target for quality improvement interventions to maximize the outcomes of CAD patients.
In a well-done recent study, Dr P. Michael Ho and colleagues confirm previous data and clinical observations that many patients are nonadherent to their cardiac medications, and, importantly, this nonadherence adversely impacts outcomes, including cardiovascular mortality.
We found sex differences in the pattern of relative strength when riskfactor associations with death from cardiovascular disease (CVD) were evaluated across different periods of follow-up. In women, an increased risk in CVD-related death was associated with diabetes mellitus and smoking; this risk was most prominent in the early follow-up period. Our finding illustrates that clinicians should employ more intense preventive measures in women who are smokers or have diabetes.