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Funding Acknowledgements Type of funding sources: None. Background Although the use of guidelines in clinical practice is emphasised, large multi-center studies of patients with cardiovascular disease have shown secondary prevention to be suboptimal, which increase the risk of recurrent events. Purpose To examine ESC guideline treatment target achievement after myocardial infarction for cardiovascular risk factors, medication use and a broad range of lifestyle factors in women and men from a Norwegian general population. Methods In a population-based study conducted 2015-2016 (65% attendance), 637 participants 40-95 years (23% women, 70% ≥65 years) had validated myocardial infarction. Cross-sectionally, we investigated target achievement for blood pressure (&amp;lt;140/90 mmHg, &amp;lt;130/80 mmHg if diabetes), LDL cholesterol (&amp;lt;1.8 mmol/L), HbA1c (&amp;lt;7.0% if diabetes), weight (body mass index (BMI) &amp;lt;25 kg/m2, waist circumference (women &amp;lt;80 cm, men &amp;lt;94 cm)), smoking (non-smoking), physical activity (self-reported &amp;gt;sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat &amp;lt;10E%, fiber ≥30g/day,  and alcohol (women ≤10 g/day, men ≤20 g/day)), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, antidiabetics) using regression models. Results Proportion of target achievement was for blood pressure 55.8%, LDL cholesterol 9.3%, HbA1c 42.7%, BMI 19.5%, waist circumference 15.6%, non-smoking 86.2%, self-reported physical activity 79.5%, objectively measured physical activity 9.1%, intake of fruits 66.7%, vegetables 38.4%, fish 96.8%, saturated fat 25.4%, fiber 29.5%, and alcohol 78.5%, use of antidiabetics 84.3%, lipid-lowering drugs 86.8%, antihypertensives 78.5% and antithrombotics 77.9%. In total, 0.8% achieved all cardiovascular risk factor targets (blood pressure, LDL cholesterol, BMI and waist circumference combined). Compared to men, a lower proportion of women achieved the target for waist circumference (6.9% vs 18.1%, p = 0.002). Compared to participants 65 years or older, a higher proportion of those 40-64 years achieved the target for blood pressure (71.2% vs 49.0%, p &amp;lt; 0.001), and a lower proportion achieved the target for BMI (15.3 vs 21.4, p = 0.007). Conclusion Secondary prevention after myocardial infarction was suboptimal in both women and men. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care after myocardial infarction is needed.

Treatment target achievement after myocardial infarction: cardiovascular risk factors, medication use and lifestyle in Norwegian women and men