Lifestyle and Socioeconomic Determinants of Coronary Artery Disease Recurrence: A Cross-sectional Study

Abstract

Background: Although the primary prevention of coronary artery disease (CAD) has been widely studied, data on factors influencing CAD recurrence, particularly in Middle Eastern populations, remain scarce. Identifying modifiable risk factors for recurrence is essential for improving secondary prevention strategies. Objectives: This study aimed to investigate the associations between demographic, clinical, and lifestyle factors and CAD recurrence in a cohort of Iranian patients. Methods: In this hospital-based, cross-sectional study, data from 300 patients with a confirmed diagnosis of CAD who had more than one hospitalization for CAD at Heshmatieh Hospital in Sabzevar, Iran, between March 2017 and March 2020 were analyzed. Data on demographics, clinical history, lifestyle behaviors (including smoking, opium use, physical activity, and diet), and medication adherence were collected using a structured checklist. Associations between these variables and the number of recurrent CAD events were evaluated using independent t-tests, chi-square tests, and Fisher exact tests. Results: The mean age of the participants was 58.7 years, and the sex distribution was nearly equal, with 49.7% being male. Lower educational level (P = 0.019), urban residence (P = 0.021), and lack of regular physical activity (P = 0.007) were significantly associated with a higher number of recurrent CAD events. Paradoxically, a higher number of follow-up visits was associated with more recurrences (P = 0.035), likely reflecting a sicker cohort. No significant associations were identified for sex, occupational stress, or traditional risk factors such as hypertension and diabetes in these analyses. Conclusions: This cross-sectional study identified associations suggesting that modifiable socioeconomic and lifestyle factors, specifically low education, urban residence, and physical inactivity, may be important determinants of CAD recurrence in this Iranian population. These findings highlight potential targets for secondary prevention but require confirmation in prospective studies. Secondary prevention programs should consider moving beyond traditional risk factor management to include interventions addressing these broader determinants of health.