Friday, April 19, 2013


Have you ever wondered how many patients after a major cardiovascular like stroke and heart attacks, listen to your advice and stick to it? Not many. Either our advice are bad, and not sustainable, or patient just don't care, once the immediate threat is gone.
Dr Koon Teo and colleagues published their finding from the PURE cohort, in the latest ( 17th April ) edition of the Journal of the American Medical association. Te PURE cohort is a cohort of 153,996 subjects across 17 countries, between the age of 35-70years. who had cardiovascular disease, and were tracked across time. PURE stands for Prospective Urban Rural Epidermiology. It was another of these large population studies organised by Dr Salim Yusuf from the McMaster University, Hamilton, Ontario. Dr Koon Teo, works with Dr Yusuf.
Well in their latest paper, they took 7,519 self confessed patients who had a heart attack, or stroke, and asked them if they were still observing their healthy lifestyle advice given by their doctors upon discharge, average of 2-8 years after discharge.
They found that 18.5% still smoke, 35% were on some form of exercise program, 39% were on a healthy diet, and 14 % were not doing any of the above. Only 3% were doing all 3.
That is not very good. Most of our advice, is going to waste.
In my experience, as I always tell my patients, adherence to healthy lifestyle last for about 1 year. In the first year following their heart attack, stroke, angioplasty or bypass surgery, the patients are good and will co-operate. After 1 year, when things are very stable, and they feel confident, their old bad habits kick it, and sheepishly, they will tell you that they are back to their smoking ( just a few ), and not exercising, and gaining weight again.
So much for all our pep talk.

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