Comment on: ‘A Cross‐Sectional Study of Risk Factors for Coronary Heart Disease in Secondary Prevention for Patients With the Disease in China’

We read the following article with great interest. 'A Cross-Sectional Study of Risk Factors for Coronary Heart Disease in Secondary Prevention for Patients With the Disease in China' (Shen et al. 2024). This study is first focused on the 'ABCDE' strategy framework to explore the risk factors for secondary prevention in patients with coronary heart disease (CHD) in China, covering multiple dimensions such as medication adherence, physical activity, self-management, anxiety and sexual health. The research not only focuses on traditional physiological risk factors but also encompasses psychological and social dimensions, such as anxiety and sexual health, providing a new perspective for comprehensive chronic disease management in elderly patients with CHD. It was conducted among patients from five regions in Hengyang City, Hunan Province, China, offering detailed data on the risk factors for CHD patients in a specific area. We are writing to draw attention to several discussions. First, the article primarily focuses on the risk factors mentioned in the 'ABCDE' strategy, such as self-management, exercise, medication adherence, anxiety and sexual health. However, potentially important risk factors in chronic diseases were not discussed in detail, such as smoking history (including quitting), obesity, depression, hyperlipidaemia, and alcohol consumption history, as well as details in medication adherence studies and the use of other medications like Aspirin, Angiotensin-converting enzyme inhibitor, Angiotensin II receptor antagonist, β-blocker and lipid-lowering drugs, These factors were in the 'ABCDE' strategy framework, which also plays a significant role in the development of CHD. Thus, the comprehensiveness of the study results may be limited. Second, the multiple linear regression analysis results indicate that the explored risk factors have limited explanatory power for self-management, exercise, medication adherence, anxiety and sexual health (with adjusted R2 values between 0.206 and 0.324). It suggests that, as we mentioned, other factors not included in this study may be affecting these outcomes. Future research was needed to explore potential risk factors, include more variables, use larger sample sizes or develop more sophisticated predictive models. Finally, the study mentions that it was conducted in Hengyang City, Hunan Province, China. However, the authors did not explain more about whether the patient cases collected were from urban or rural communities. It is mentioned that some residents have Rural cooperative medical care. It is well known that elderly people in rural areas may have lower levels of education and engage in more physically demanding labour; whether such regional factors served as significant confounding factors in this study and further stratified research may be needed. Overall, this article provides valuable insights into the risk factors for secondary prevention in patients with CHD in China. Future research needs to overcome these limitations to more comprehensively understand the impact of risk factors on CHD and to develop more effective interventions to improve patient outcomes and reduce recurrence and mortality rates. The author declares no conflicts of interest. The data sets used and/or analysed during the current study are available from the corresponding author upon reasonable request.