The purpose of this paper was to examine the influence of adherence to behavioral recommendations on risk of short-term cardiovascular outcomes. The study population included 18,809 patients from 41 countries enrolled in the Organization to Assess Strategies in Acute Ischemic Syndromes (OASIS) 5 randomized clinical trial. This study found that adherence to recommendations concerning smoking, diet, and exercise at 30 days after an acute coronary syndrome (ACS) is associated with a substantially lower rate of short-term major cardiovascular outcomes and all-cause mortality. Quitting smoking was associated with about half the risk of repeat myocardial infarction (MI) compared with persistent smokers. Diet and exercise adherence was also associated with a decreased risk of MI compared with nonadherence. Persistent smoking and non-adherence to diet and exercise were associated with a 3.8-fold (95% CI: 2.5-5.9) increased risk of cardiovascular events (MI, stroke and death) compared with the risk of never smokers who had modified their diet and exercise habits. These results highlight the notion that behavioral modification should be reinforced immediately after MI because of the marked improvement in cardiovascular morbidity and mortality. In their comment, Patel NB et al. emphasized the importance of implementing a cardiac rehabilitation program that included nutritional counselling, risk factor management (lipids, blood pressure, weight, diabetes and smoking), psychosocial interventions, physical activity counselling, and exercise training as recommended by the American Heart Association.
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