175 General discussion 7 fragmented literature on medication use in South America. This thesis also explores research questions that had not been previously investigated in CHD patients. Sex differences in the occurrence of multiple risk factors had been only studied in primary prevention (38–42), and reported conflicting results. Our results of the CESCAS study show a higher prevalence of multiple risk factors in women in the Southern Cone of Latin America, especially those with lower education (Chapter 4) (33). Risk factor awareness in secondary prevention has been studied from a gender perspective (43), whereas our research in the EUROASPIRE V study (Chapter 5) explores other patient characteristics related to awareness. In this analysis, we show that hypertensive patients with CHD who are aware of their hypertensive condition, blood pressure measurement result and target level have an overall worse risk factor profile, but are more likely to change health behaviors. We additionally highlight the need to study risk factor awareness with a prospective design to gain insights into its role on risk factor control. RELEVANT ASPECTS FOR SURVEYS IN SECONDARY PREVENTION Research on secondary prevention of CHD is key to understand the challenges of risk factor control and eventually support the design of effective prevention strategies. Surveys are a useful tool to obtain demographic and health information necessary for research in CHD patients. Existing surveys in secondary prevention differ in terms of the information they register, their methodologies, and the patient population they include. In the following sections, we discuss the essential features of surveys that make them valuable to capture relevant information and to promote improvement of secondary prevention of CHD. Topic of surveys in secondary prevention Surveys in secondary prevention can be useful to investigate various topics, including risk factor levels, adherence to clinical guidelines, patient outcomes, and patient characteristics and health inequalities. The topic that the surveys aim to address will determine which information they should capture. Risk factor levels Clinical guidelines define risk factor goals for smoking cessation, physical activity, body weight, blood pressure, lipids, and glucose levels (5,44). Reporting the levels of risk factors and of risk factor target attainment provides researchers and clinicians with a picture of the state of secondary prevention. This allows for the identification of risk factors with low control levels for further research and to guide prevention priorities. Surveys in secondary prevention collect information on traditional cardiovascular risk factors (11,24,45,46), and comprehensive surveys also include information on psychosocial and sex-specific risk factors, as well as detailed information on dietary habits (47). Adherence to clinical guidelines In order to improve risk factor measurements and meet risk factor targets, clinical guidelines recommend that patients change their lifestyle and use cardioprotective medications (5).
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