Abstract 1403: Factors Associated With Short-term Adherence to Dietary and Lifestyle Guidelines in Secondary Prevention of Acute Myocardial Infarction in France
Adherence to dietary and lifestyle guidelines (DLG) plays a major role in secondary prevention after acute myocardial infarction (AMI). A population-based cohort study of patients included by cardiologists after recent AMI (<3months) was done to assess DLG adherence in real life practice. Adherence to DLG was evaluated by a 23-item composite score, estimated after 6 months of follow-up, taking into account evolution since inclusion of diet (21 items), tobacco use (1 item) and physical activity (1 item). Each item was scored −1 for worsening, 0 for no change from inclusion and +1 for improvement. Each patient’s DLG score was the mean of the 23 items. Linear regression models were used to assess factors associated with DLG score. Inclusion variables tested were socio-demographic, clinical, dietary and lifestyle habits. From May 2006 to March 2008, 1575 subjects were included and provided all the data needed for this analysis: 56% were aged 60 years or more, 81% were male, 9.3% were smokers and for 40% a cardiovascular rehabilitation program was prescribed. This was the first AMI for 87%. For 6.7%, LVEF was <40%. After 6 months of follow-up, median DLG score was +0.35, i.e., an improvement in overall DLG compliance. The variables statistically most strongly associated (p<0.01) with more improvement of DLG score in the final multivariate model were: prescription of cardiovascular rehabilitation program at inclusion, education above primary school, high consumption of at-risk food before inclusion (delicatessen-type food, pastries and alcohol), previous history of hypercholesterolemia, and large waist circumference at inclusion (≥94cm for men, ≥80cm for women). On the opposite, age > 60 years, smoking at inclusion, and female gender were associated with less improvement of DLG score. The factor most strongly associated with 6-month DLG improvement was the prescription of a cardiovascular rehabilitation program: this result underscores the interest of such interventions. Taken together, the results indicate that patients with a high dietary risk profile adhered to DLG. The elderly, smokers and female subjects require particular attention because of a high risk of worse compliance to DLG.