Optimizing cardiovascular risk control after an acute coronary syndrome: the role of a structured follow-up program

Effective secondary prevention after an acute coronary syndrome (ACS) remains a challenge, particularly in achieving optimal control of cardiovascular risk factors (CVRF). This study aimed to evaluate the impact of a Structured Coronary-Disease Follow-up Program (SCCC) on the management of key CVRFs 12 months after ACS. A comparative analysis was conducted between patients enrolled in the SCCC and a historical cohort receiving routine care (RCC). Primary outcomes included low-density lipoprotein cholesterol (LDL-C), glycated hemoglobin (HbA1c) in patients with diabetes mellitus, systolic blood pressure (SBP), and smoking cessation at 12 months. Intragroup changes were assessed using paired Wilcoxon tests, while the program’s impact was evaluated through analysis of covariance (ANCOVA) and logistic regression. A total of 521 patients were included (237 SCCC, 284 RCC). In the SCCC group, significant reductions were observed in LDL-C [from 99 (interquartile range, IQR: 74-126) to 52 (IQR: 43-66) mg/dL, p<0.001], HbA1c [from 7.00% (IQR 6.30-7.60) to 6.40% (IQR 6.10-6.85), p<0.001], and SBP [from 134 (IQR 120-145) to 130 (IQR 117-140) mmHg, p<0.001]. ANCOVA confirmed the program’s significant impact on LDL-C (β=-13.0, p<0.001), HbA1c (β=-0.49, p=0.026), and SBP (β=-3.5, p=0.018). No significant difference was observed in smoking cessation (p>0.9). In conclusion, implementation of a structured follow-up program after ACS was associated with improved control of LDL-C, HbA1c, and SBP, supporting the role of coordinated post-ACS care in enhancing CVRF management.