Modifying Behaviors in Patients With Coronary Heart Disease.

In order to investigate the high prevalence of cardiovascular risk factors in the Munster region in Germany, we conducted the COSIMA study (“Coronary Secondary Prevention in the Munster Area”) at the Institute of Epidemiology and Social Medicine at Munster University from 2002 to 2004. In the context of this study, we surveyed 1000 doctors in private practice (1), as well as 1000 patients with a coronary event (2), whose practice or place of residence were located in the study area. Most of the patients were able to correctly list the most important risk factors for coronary heart disease (smoking, hypertension, hypercholesterolemia, high alcohol consumption, and overweight) with correct answers of >50% each, and recognized the need for modifying their lifestyle because of the disease. According to patients’ self-report, compliance with their doctors’ treatment recommendations was good, because only 7.9% of patients reported difficulties in following these recommendations. Detailed analyses of modifications of relevant coronary risk factors according to the transtheoretical model by Prochaska and DiClemente (TTM) (3), however, painted a more differentiated picture: 37% of patients who smoked, 51% of overweight patients with a BMI > 25 kg/m2 who had not attempted to lose weight in the past, and 52% of physically inactive patients were not considering any behavioral change (corresponding to the precontemplation stage in the TTM). Analogously, only few of these patients had reached the preparation stage: 17% for smoking cessation, 24% for increasing physical activity, and 18% for weight loss. Our data therefore underline the importance of education and treatment programs in the context of secondary prevention of coronary heart disease, which can support patients in achieving a long-term modification of cardiovascular risk factors (4).