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Traditional risk factors: The who have experienced AMI if secondary prevention measu-
Seven Countries Study and res are inadequately implemented.
the Framingham Study The Framingham Study began at a time when little was
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The Seven Countries study was the first epidemiological known about coronary heart disease and the risk factors le-
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study to investigate the impact of diet and physical activity ading to its development. Initiated in 1948 in Framingham,
on the development of cardiovascular diseases. a town of 28.000 residents near Boston University, it was se-
lected to conduct one of the largest epidemiological studies
Keys and colleagues observed significant diversity in on cardiovascular diseases .
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dietary patterns and saturated fat intake across 15 different
cohorts of patients from seven countries (former Yugoslavia At first, the study included 5,209 healthy individuals. The
original aim was to identify common factors or characteri-
Scheme 1. Cardiovascular Risk and Risk Factors in Patients with stics for the development of cardiovascular diseases over a
Established Atherosclerotic Cardiovascular Disease 8 twenty years. The initial results (1961) indicated that there
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were risk factors such as gender, age, elevated blood pre-
ssure, cholesterol, obesity, and left ventricular hypertrophy
(assessed by electrocardiogram) that contribute to the de-
velopment of coronary heart disease . Soon, other factors
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were recognized, such as smoking and physical inactivity.
The first risk prediction model was formulated in 1967. In
the early 1970s, the study was extended, and the exami-
ned group was expanded to include a second generation
(descendants) of individuals initially included in the study.
A third generation of relatives was included in 2002. The
Framingham Study thus became a multigenerational study
Legend: SBP - Systolic Blood Pressure; LDL - Low Denisty lipoprotein; DAPT - Dual Anti- analyzing familial, genetic patterns for cardiovascular and
platelet Therapy; DPI - Dual Pathway Inhibition.
other diseases. In the 1990s, two additional independent
was included with two cohorts: Croatia and Serbia - Zrenja- cohorts were added to better understand differences in risk
nin, Mala Krsna, and Belgrade). There was a notable diffe- profiles associated with racial and ethnic characteristics.
rence in cholesterol levels and the incidence of coronary he-
art disease among the population, both in the five-year and
ten-year follow-up periods. This association was confirmed The importance of the Framingham study
in the twenty-five-year and fifty-year mortality follow-up, le-
ading to the formulation of the Mediterranean Adequacy In- The impressive results of the research established the
dex (MAI) . The MAI is calculated by dividing the sum of the concept of risk factors, enabling an understanding of the-
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percentages of energy from typical Mediterranean diet food ir impact on the onset of initial manifestations of coronary
groups recommended for a healthy diet (such as grains, le- artery disease, better recognition of subclinical forms, and
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gumes, vegetables, fresh fruits, nuts, fresh fish, wine, and the physiological profile leading to the development of co-
olive oil) by the sum of energy from less typical food items, ronary artery disease (with the help of echocardiography,
the consumption of which is not recommended or limited ambulatory electrocardiogram monitoring, stress tests, bio-
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(such as milk, cheese, meat, eggs, animal fats, margarine, markers, multidetector computed tomography of the heart,
pastries, sugar, sweets, and sweetened beverages). High cardiac magnetic resonance imaging, serial vascular tono-
MAI values were associated with higher mortality rates after metry, and accelerometry), paving the way for further rese-
25 years and 50 years (R = -0.84 and R = -0.91, respectively, arch. Additionally, they contributed to a better understan-
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and R = -0.62 after adjustment for socioeconomic status). ding of risk factors for heart failure and atrial fibrillation .
Recognizing its importance, physical activity was inclu- By detailed formulation of risk factors and their clinical
ded in the content of the first cardiovascular rehabilitation parameters, the findings have been implemented into mo-
programs in 1968, according to the recommendations of dels for individual assessment of ten-year and thirty-year
the World Health Organization. Today, there is intensive re- risk for cardiovascular disease (CVD).
search on the optimal and therapeutic prescription of physi-
However, mortality in the first year after AMI was high.
cal activity through programs specially designed for secon- One in five patients had a fatal outcome, and in the next five
dary prevention - cardiac rehabilitation based on physical
activity, which is an integral part of the treatment of these years of follow-up, an additional 23% experienced a fatal
. The prognosis
outcome. Women had a worse prognosis
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patients 11-13 .
of patients was unsatisfactory, so it was not surprising that
The initial results of the leading American study, which this subgroup of patients became the focus of research.
celebrated its 75 -anniversary last year, have indicated the At that time, mortality in the acute phase of AMI was at
th
existence of factors influencing an increased risk in patients least 33%, and it was significantly reduced by establishing
REVIEW PAPER Galenika Medical Journal, 2024; 3(9):42-47. 43