Secondary Prevention in Coronary Artery Disease and Myocardial Infarction

Despite considerable effort in primary prevention, coronary heart disease continues to be the leading cause of death in the industrialized nations. The patient who survives his first myocardial infarction carries approximately a tenfold risk of recurrence and sudden death when compared to the normal population. The concept of secondary prevention, therefore, has emerged as an active strategy aimed at the reduction of fatal and non-fatal recurrences of myocardial infarction. Apart from risk factors of relevance in primary prevention, secondary prevention is dependent on the extent of the disease itself; in other words the number of vessels involved, the extent of myocar- dial damage and the degree of electrical instability. Nonmedical aspects such as the level of education, the degree of social support and the attitude towards stress also appear to influence the prognosis. The aim of this volume is to bring together all those factors relevant to achieving the maximal life span in patients afflicted with a disease that by its very nature is a lifelong process. However, as the late Paul Dudley White stated appropriately more than 40 years ago, it is not sufficient merely to add years to a life, one should also add life to the years. This concept truly is the nucleus of secondary prevention, sine only a life worth living generates the motivitation needed to take all the steps necessary in secondary pre- vention. The authors and the editor are most grateful to Pharma Schwarz Inc.