ORIGINAL ARTICLES   

International Angiology 2012 June;31(3):260-70

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Beware of suboptimal medical management of patients with atherosclerosis requiring revascularization

Le Hello C. ¹, Morello R. ², Fradin S. ³, Coffin O. ⁴, Maïza D. ⁴, Hamon M. ⁵ ✉

¹ Department of Vascular Medicine, CHU of Caen, Caen, France; ² Department of Statistics and Clinical Research, CHU of Caen, Caen, France; ³ Department of Biochemistry, CHU of Caen, Caen, France; ⁴ Department of Vascular Surgery, CHU of Caen, Caen, France; ⁵ Department of Cardiology, CHU of Caen, Caen, France

AIM: The aim of this paper was to assess a daily-life evaluation of vascular risk factor control, pharmacological treatment and prognosis in patients with atherosclerosis referred for revascularization.
METHODS: Prospective observational study conducted in a French University Hospital with collection of atherosclerosis referral site information, reported patient history, documented atherosclerosis sites seen on examination, biological data, and clinical outcomes.
RESULTS: 956 patients (82.6% men, 64.5±10.1 years) were enrolled for supra-aortic vessel disease (SVD, 24.6%), coronary heart disease (CHD, 40.4%), peripheral artery occlusive disease (PAOD, 34.2%), and visceral artery disease (1.7%). Involvement of >2 vascular territories was documented in 85%. Vascular risk factor frequency results were: previous (65.7%) or current (10.6%) tobacco use, hypertension (64.3%), hyperlipidaemia (75.4%), diabetes (25.8%), overweight (43.8%), and obesity (25.2%). LDL-cholesterol was >100 mg/dL for 38.1%, most frequently seen in patients with PAOD referral (P<0.001) or history (P=0.002), and for 29.2% of the patients taking a statin. HbA1c levels were >6.5% for 53.8% of patients with diabetes. The triple combination of an antiplatelet agent, a statin, and a renin-angiotensin–system inhibitor was not prescribed often enough, especially for PAOD referrals (PAOD referrals, 45.1%; SVD referrals, 48.1%; CHD referrals, 65.9%). Independent risk factors for all-cause mortality were: a previous CHD or PAOD clinical event, body mass index <25 kg/m2, HbA1c >6.5%, and no aspirin treatment.
CONCLUSION: Even at the time of revascularization, medical management of atherosclerosis was not optimal. The need for continuing education of physicians and patients remains essential.