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Living through a heart attack or stroke might seem to be a wake-up call, prompting patients to make major life changes to reduce their risk. However, the results of a new study suggest that many survivors of a heart attack or stroke don't make enough changes in their diet and lifestyle or take adequate medication to prevent a second heart attack or stroke.

In a study of more than 1,200 US adults who had experienced a heart attack, stroke or both, Dr. Adnan I. Qureshi of the State University of New York at Buffalo and colleagues found that more than one third of the patients still had at least two major risk factors for heart attack and stroke.

In the report, the researchers noted that the risk of a heart attack was three to six times greater in people who already had a heart attack. Thirty percent of stroke survivors may go on to have another stroke, according to the report.

The investigators noted that 46% of patients who had been previously diagnosed with high cholesterol, a risk factor for both heart attack and stroke, still had high cholesterol. Almost half of the subjects with diabetes, which is a major risk factor for heart disease, did not have their blood sugar levels under control.

Of the patients who had been diagnosed with high blood pressure before the heart attack or stroke, 53% still had high blood pressure, the researchers reported. Previously undetected high blood pressure was found in another 11% of patients.

The study, which was based on a national survey, also found that many patients were not following a low-fat diet as recommended. Even though smoking increases the risk of both heart attack and stroke, nearly one out of every five heart attack and stroke survivors was a current smoker, according to the Archives of Internal Medicine (2001;161:1621-1628).