Risk factors in cardiovascular patients:Challenges and opportunities to improve secondary prevention

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

Myocardial infarction secondary prevention study (MISPS)

Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries.

Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases

Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families.It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle,and so modification of the latter is an essential component of both primary and secondary prevention.Cardiac rehabilitation(CR)represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity.This review presents an overview of basic information on CR with a focus on current trends,such as the issue of the various training modalities,utilization,and barriers to it or the use of telemedicine technologies.Appropriate attention should be devoted to these domains,as CR continues evolving as an effective and readily available intervention in the future.

Secondary prevention of recurrence by interferon therapy after ablation therapy for hepatocellular carcinoma in chronic hepatitis C patients

Chronic hepatitis C is a leading cause of hepatocellular carcinoma (HCC) worldwide.Interferon (IFN) ther-apy decreases the incidence of HCC in patients with chronic hepatitis C.Prevention of chronic-hepatitis-C-related HCC is one of the most important issues in current hepatology.We have previously reported that male gender and high titer of hepatitis C virus (HCV) RNA are predictive factors for the development of HCC in HCV-related cirrhosis.Clinical efforts at eradicat-ing or reducing the viral load may reduce the risk for HCC.Furthermore,because HCC often recurs after ablation therapy,we performed a trial of IFN in pa-tients with chronic liver disease caused by HCV to see whether IFN therapy decreases recurrence after abla-tion therapy of HCV-related HCC.By using IFN therapy as a secondary prevention,patients with HCC who had received complete tumor ablation showed better sur-vival,primarily as a result of the preservation of liver function and also probably prevention of recurrence.Postoperative IFN therapy appears to decrease recur-rence after ablation therapy such as radiofrequency ablation (RFA) therapy of HCV-related HCC.We believe that there is a survival benefit in secondary prevention using IFN therapy.However,a controlled study is es-sential to obtain conclusive evidence of the efficacy of this strategy.

The influence of treatment modality on illness perception and secondary prevention outcomes among patients with acute myocardial infarction

Objectives:This study aims to determine if patients with acute myocardial infarction differ in illness perception and secondary prevention outcomes depending on the treatment they received.Methods:A repeated measures design was used to compare patients with acute myocardial infarction receiving three different treatment modalities:ST-elevation myocardial infarction treated by primary percutaneous coronary intervention,ST-elevation myocardial infarction treated by thrombolytic therapy,and non ST-elevation myocardial infarction treated by medication.A convenient sampling technique was used to recruit 206 patients with acute myocardial infarction who agreed to participate in the current study.Patients'illness perception,physical activity,and demographical and clinical data were collected during hospital admission and again at 6 months.Results:A total of 186 patients completed the study.Results showed that the primary percutaneous coronary intervention group perceived their illness as acute rather than chronic(P=0.034)and has lower personal control(P=0.032),higher treatment control(P=0.025),and higher perception of illness coherence(P=0.022)compared with patients receiving thrombolytic therapy and treated after non-ST segment infarction.Moreover,they report low control of their blood pressure(P=0.013)and less physical activity(P=0.001).Conclusion:The results of this study revealed that patients'treated with primary percutaneous coronary intervention had negative illness perception and limited behavioral changes 6 months after hospitalization in comparison with other treatment modalities such as percutaneous coronary intervention and thrombolytic treatment.Further research is recommended to confirm this association with longer follow-up study and among different cultures.

Physical activity in primary and secondary prevention of cardiovascular disease:Overview updated

Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.

Awareness intervention for Beijing neurologists regarding secondary prevention of cerebral infarction/transient ischemia Cross-sectional investigation

BACKGROUND： Stroke prevention guidelines should be made available application to aid in uniformity, timing, preciseness, and acceptance of disease. OBJECTIVE： To investigate the awareness of neurologists in some Beijing secondary prevention of cerebral infarction/transient ischemia. DESIGN： Cross-sectional study. to neurologists for clinical hospitals of intervention in SETTING： Beijing Tiantan Hospital, Beijing Anzhen Hospital, General Hospital of Beijing Military Area, Command of Chinese PLA, Beijing Chuiyangliu Hospital, Beijing 6^th Hospital, Beijing Hepingli Hospital, and Beijing Daxing District Hospital. PARTICIPANTS： A total of 28 （associate） chief physicians, 58 attending physicians, and 54 resident physicians who engaged in clinical treatment of cerebrovascular diseases were selected from 8 hospitals in Beijing from March to April 2007. All physicians provided informed consent. METHODS： Self-made closed questionnaires were provided for data collection, consisting of 16 questions that were single choice or multiple choice. Specifically, questions 1-7 focused on awareness of blood pressure regulation in different patients and first choice of decompression drug; questions 8-12 focused on awareness of lipid regulation; and questions 13-16 focused on awareness of anti-blood platelet drugs applied in secondary prevention. The scores ranged from 0-100 points, and each question was worth 6.25 points. The scores positively correlated with the awareness rate. To test leveling real-time, the survey lasted for a maximum of 20 minutes. One questionnaire was independently finished by each subject in the survey. MAIN OUTCOME MEASURES： Awareness intervention among neurologists during secondary prevention of cerebral infarction/transient ischemia and questionnaire scores. RESULTS： 140 subjects were included in the final analysis. ① The awareness rate among neurologists for intervention during secondary prevention of cerebral infarction/transient ischemia ranged from 0.7-57.9%, the scores ranged between 0-56 points, and the mean score was 26 points.② Scores of resident physicians were 0-56 points with a mean score of 26 points; attending physicians scored 6-50 points, with a mean score of 26 points; and chief physicians scored 6-50 points, with a mean score of 23 points. There were no significant differences among the various physicians （F = 0.771, t = 0.465, P 〉 0.05）. CONCLUSION： Awareness among neurologists of intervention during secondary prevention of cerebral infarction/transient ischemia is not ideal. However, there was no significant difference between professional titles.

A Commentary on the Chinese Coronary Secondary Prevention Study

Chinese coronary secondary prevention study （CCSPS） is a key project in the field of medicine of the Ninth Five-year Plan of China, and is also called the Study of Xuezhikang Capsule （血脂康胶囊, XZK）in regulating blood lipids for secondary prevention of coronary heart diseases .Since the results of the study was publicized in June 2004 at the news release and deliberation by experts took place in the Great Hall of the People in Beijing, wide attention and high opinions have been gotten, and at the same time,

Exploring the Role of Nutraceuticals (Red Yeast Rice) in Secondary Prevention: A New Pathway Can Be Opened

Background: Long-term survival in acute coronary syndrome has increased steadily in the last decades. Follow-up studies developed in this patient clearly reveal that they are at risk of suffering a new event, placing them in a new stage, secondary prevention. Assuming this increased risk, the control target of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, has arisen as a priority objective in patients with coronary arterial disease. In this sense, management of dyslipidemia guidelines, recently recognises the role of functional food, highlighting among them is the Red Yeast Rice (RYR). The aim of the study is to establish the potential role of functional food, in secondary prevention, while determining its additional capacity to reduce LDL-C in patients that despite optimal classic treatment (maximum tolerated dose of stain plus Ezetimibe) is still out of control objectives. Results and Discussion: 88 patients were included and after 3 months of treatment with RYR, their lipid profiles were compared with the baseline. The variation of T-Col, LDL-C and Trig were statistically significant. A reduction in LDL-C was 10.73 mg/dL, which means a 10.93% of additional reduction over the standard therapy the patients were receiving. Concerning security, no relevant side effects were reported when adding RYR, even in a relevant percentage (35.4%), myalgia disappeared (especially when reducing the titrating dose of the statin). Conclusion: Adding RYR in secondary prevention patients in combination with the usual treatment, seems to be an effective alternative to optimize LDL levels and thus gets closer to the target set in the guidelines, without adding relevant side effects, and even improving tolerance to the statins.

Use of Evidence-Based Pharmacotherapy for Secondary Prevention of Coronary Heart Disease:A Chinese Medicine Hospital Versus A General Hospital

Objective： To determine differences in adherence to secondary prevention guidelines （pharmacological interventions） among coronary heart disease （CHD） patients between a Chinese medicine （CM） hospital and a general hospital in a Chinese city. Methods： Medical records of 200 patients consecutively discharged from the CM hospital and the general hospital for CHD were reviewed to determine the proportions of eligible patients who received antiplatelet agents, 13-blockers, angiotensin-converting enzyme （ACE） inhibitors or angiotensin receptor blockers （ARBs） and statins at discharge. The effects of patient characteristics and hospital type on the use of these medicines were estimated using logistic regression models. Results： Patients discharged from the CM hospitals were older; more likely females; had greater history of hyperlipidemia, cerebrovascular diseases and less smoker （P〈0.01 or P〈0.05）. They were less likely to receive coronary angiography and percutaneous coronary intervention, and had a longer length of stay than those discharged from the general hospital （P〈0.01 or P〈0.05）. There were no significant differences in antiplatelet agents （96% vs. 100%, P=0.121） or statins （97.9% vs. 100%, P=0.149） use between the CM hospital and the general hospital. In multivadable analyses that adjusted for patient characteristics and hospital type, there was no significant difference in use of 13 -blockers between the CM hospital and the general hospital. In contrast, patients discharged from the CM hospital were less likely to receive ACE inhibitors/ARBs compared with those discharged from the general hospital （odds ratio： 0.3, 95% confidence interval： 0.105-O.854）. Conclusion： In this study, the CM hospital provides the same quality of care in CHD for prescribing evidence-based medications at discharge compared with another general hospital except for ACE inhibitors/ARBs use.

The utilization status of aspirin for the secondary prevention of ischemic stroke

Background The present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly taking aspirin. Methods The patients in this group were all stroke survivors who have formerly been diagnosed with a cerebral infarction or transient ischemic attack （TIA） in our hospital. We investigated their use of aspirin over a three-year period following their hospitalization. According to the patients＇ aspirin usage, they were divided into treatment and non-treatment groups. In addition, the reasons for not taking or irregularly taking aspirin were analyzed in the two groups. Results A total of 1240 patients were studied, including 367 （29.60%） in the treatment group and 873 （70.40%） cases in the non-treatment group. In addition, 201 （16.20%） cases in the treatment group had been regularly taking aspirin （50-325 mg of aspirin daily） for 1 to 3 years or longer. The results demonstrated that the main reasons for not taking aspirin in this study were related to patients＇ concerns regarding the side effects of taking aspirin （46.45%）, as well as the doctors＇ inadequacy in informing their patients to take aspirin （38.71%）. The major reasons for patients to irregularly take aspirin were that the doctors did not notify the length of aspirin usage to their patients （41.57%）, and that doctors did not prescribe aspirin upon the patients＇ follow-up visit （26.51%）. Conclusion The most effective way to increase patient＇s compliance for aspirin consumption is to promote the guidelines for stroke treatment and to relay these advances in stroke therapy to the patient. Chin Med J 2009; 122（2）： 165-168

Naoxintong Capsule for Secondary Prevention of Ischemic Stroke:A Multicenter,Randomized,and Placebo-Controlled Trial

Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese medical centers participated in this trial.Adult patients with a history of ischemic stroke were randomlyassigned ina 1:1ratiousing a blockdesign toreceive eitherNaoxintong Capsule(1.2gorally,twice a day)or placebo in addition to standard care.The primary endpoint was recurrence of ischemic stroke within 2 years.Secondary outcomes included myocardial infarction,death due to recurrent ischemic stroke,and all-cause mortality.The safety of drugs was monitored.Results were analyzed using the intention-to-treat principle.

Primary and secondary prevention of colorectal cancer: An evidence- based review

Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.

Vorapaxar in patients with diabetes mellitus and previous myocardial infarction: Findings from the thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events-TIMI 50 trial

Background Vorapaxar reduces cardiovascular death, myocardial infarction （MI）, or stroke in patients with previous MI while increasing bleeding. Patients with diabetes mellitus （DM） are at high risk of recurrent thrombotic events despite standard therapy and may derive particular benefit from antithrombotic therapies. The Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50 trial was a randomized, double-blind, placebo-controlled trial of vorapaxar in patients with stable atherosclerosis.

Influence of education and working background on physicians' knowledge of secondary prevention guidelines for coronary heart disease: results from a survey in China

Background and objective： In clinical practice, the standard of secondary prevention for coronary heart disease （CHD） is quite disappointing in China. The physicians＇ shortage of knowledge of secondary prevention guidelines is thought to be a key factor contributing to the inadequate and delayed translation of guidelines into clinical practice. The purpose of this study is to investigate the influence of physicians＇ characteristics, including their educa- tion and work experience, on their knowledge of secondary prevention in China. Methods： A representative ques- tionnaire survey was made of physicians from cardiology departments in 35 tertiary hospitals in China. The survey contained 19 questions on knowledge of guideline recommendations for the secondary prevention of CHD. We col- lected basic information about the physicians, including their educational degree, clinical practice duration/work experience and geographic region. Results： In total, 864 physicians participated in the survey. Eight hundred and thirty-seven completed questionnaires were analyzed. For 6 of the 19 questions, physicians with a postgraduate degree were more likely to answer correctly than those without such a degree. For 11 of the 19 questions, physicians with more than three years＇ clinical experience were more likely to answer correctly than those who had less than three years＇ experience. For 5 of the 19 questions, physicians.from eastern areas were more likely to answer correctly than those from mid/western areas. The mean total score of correct answers to the questionnaire was 11.69 points. Edu- cational degree and clinical practice duration affected total scores significantly while practice location did not （β=0.500, P=0.004; ,β=0.979, P=0.000; and 8=0.228, P=0.162, respectively）. Even if a relatively low score of 12 is taken as a threshold level of acceptable knowledge （defined as a pass）, the pass rate of all physicians was only 53.9%. Educational degree and clinical practice duration affected pass rate significantly while practice location did not （95% CI： 1.222-2.248, P=0.001; 95% CI： 1.773-3.140, P=0.000; and 95% CI： 0.993-1.758, P=0.056, respectively）. Conclu- sions： Physicians with a clinical practice duration of more than three years knew more about secondary prevention guidelines than those with less experience. Physicians with a postgraduate degree knew more about secondary prevention guidelines than those without a postgraduate degree. However, overall knowledge of secondary prevention guidelines for CHD was poor among this group of physicians from tertiary hospitals.

Management of cerebral amyloid angiopathy and atrial fibrillation:We are still far from precision medicine

The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.

Assessment of post-myocardial infarction lipid levels and management:Results from a tertiary care hospital of Pakistan

BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction(MI)patients at a tertiary care hospital in Pakistan.METHODS In this cross-sectional study,we analyzed patients who had experienced their first AMI event in the past 3 years.We assessed fasting and non-fasting lipid profiles,reviewed statin therapy prescriptions,and examined patient compliance.The recommended dose was defined as rosuvastatin≥20 mg or atorvastatin≥40 mg,with target total cholesterol levels set at<160 mg/dL and target low-density lipoprotein cholesterol(LDL-C)at<55 mg/dL.RESULTS Among 195 patients,71.3%were male,and the mean age was 57.1±10.2 years.The median duration since AMI was 36(interquartile range:10-48)months and 60% were diagnosed with ST-segment elevation MI.Only 13.8% of patients were advised to undergo lipid profile testing after AMI,88.7% of patients were on the recommended statin therapy,and 91.8% of patients were compliant with statin therapy.Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range.Hospital admission in the past 12 months was reported by 14.4%,and the readmission rate was significantly higher among non-compliant patients(37.5%vs 5.6%).Subsequent AMI event rate was also significantly higher among non-compliant patients(43.8%vs 11.7%).CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose,the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.

Future clinical prospects of C-peptide testing in the early diagnosis of gestational diabetes

Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term complications for both maternal and offspring health.C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin.It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin.Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis.Inadequate compensation by islet beta-cells results in hyperglycemia.The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis.Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes.Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.

Update on the prevention of local recurrence and peritoneal metastases in patients with colorectal cancer

The prevention of a disease process has always been superior to the treatment of the same disease throughout the history of medicine and surgery. Local recurrence and peritoneal metastases occur in approximately 8% of colon cancer patients and 25% of rectal cancer patients and should be prevented. Strategies to prevent colon or rectal cancer local recurrence and peritoneal metastases include cytoreductive surgery and hyperthermic perioperative chemotherapy (HIPEC). These strategies can be used at the time of primary colon or rectal cancer resection if the HIPEC is available. At institutions where HIPEC is not available with the treatment of primary malignancy, a proactive second-look surgery is recommended. Several phase II studies strongly support the proactive approach. If peritoneal metastases were treated along with the primary colon resection, 5-year survival was seen and these results were superior to the results of treatment after peritoneal metastases had developed as recurrence. Also, prophylactic HIPEC improved survival with T3/T4 mucinous or signet ring colon cancers. A second-look has been shown to be effective in two published manuscripts. Unpublished data from MedStar Washington Cancer Institute also produced favorable date. Rectal cancer with peritoneal metastases may not be so effectively treated. There are both credits and debits of this proactive approach. Selection factors should be reviewed by the multidisciplinary team for individualized management of patients with or at high risk for peritoneal metastases.