Journal Article

Risk Factor Optimization and Guideline-Directed Medical Therapy in US Veterans With Peripheral Arterial and Ischemic Cerebrovascular Disease Compared to Veterans With Coronary Heart Disease

Deswal, Anita, Ballantyne, Christie M., Nasir, Khurram, Taylor, Addison, Jneid, Hani, Hira, Ravi S., Ramsey, David J., Nambi, Vijay, Virani, Salim S., Denktas, Ali, Pokharel, Yashashwi, Akeroyd, Julia M., Cowart, Jennifer B., Petersen, Laura A.

2016

Overview

Cardiovascular disease (CVD) is a systemic process involving multiple vascular beds and includes coronary heart disease (CHD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). All these manifestations are associated with an increased risk of subsequent myocardial infarction, stroke, and death. Guideline-directed medical therapy is recommended for all patients with CVD. In a cohort of US veterans, we identified 1,242,015 patients with CVD receiving care in 130 Veterans Affairs facilities from October 1, 2013 to September 30, 2014. CVD included diagnoses of CHD, PAD, or ICVD. We assessed the frequency of risk factor optimization and the use of guideline-directed medical therapy in patients with CHD, PAD alone, ICVD alone, and PAD + ICVD groups. A composite of 4 measures (blood pressure <140/90 mm Hg, A1c <7% in diabetics, statin use, and antiplatelet use in eligible patients), termed optimal medical therapy (OMT) was compared among groups. Multivariate logistic regression was performed with CHD as the referent category. CHD comprised 989,380 (79.7%), PAD alone 70,404 (5.7%), ICVD alone 163,730 (13.2%), and PAD + ICVD 18,501 (1.5%) of the cohort. Overall, only 36% received OMT with adjusted odds ratios of 0.54 (95% CI 0.53 to 0.55), 0.77 (0.76 to 0.78), and 0.97 (0.94 to 1.00) for patients with PAD alone, ICVD alone, and PAD + ICVD, respectively, compared with patients with CHD. In conclusion, OMT was low in all groups. Patients with PAD alone and ICVD alone were less likely to receive OMT than those with CHD and PAD + ICVD.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Anticoagulants - therapeutic use / Blood Pressure / Brain Ischemia - complications / Brain Ischemia - drug therapy / Brain Ischemia - epidemiology / Cardiovascular / Cardiovascular disease / Cerebrovascular Disorders - drug therapy / Cerebrovascular Disorders - epidemiology / Coronary Disease - drug therapy / Coronary Disease - epidemiology / Diabetes / Diabetes Mellitus - drug therapy / Diabetes Mellitus - epidemiology / Diabetes Mellitus - metabolism / Female / Glycated Hemoglobin A - metabolism / Guideline Adherence - statistics & numerical data / Health risk assessment / Heart attacks / Hospice care / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Hypertension / Hypertension - drug therapy / Hypertension - epidemiology / Illnesses / Logistic Models / Male / Middle Aged / Multivariate Analysis / Odds Ratio / Optimization / Patients / Peripheral Arterial Disease - complications / Peripheral Arterial Disease - drug therapy / Peripheral Arterial Disease - epidemiology / Pharmacy / Platelet Aggregation Inhibitors - therapeutic use / Practice Guidelines as Topic / Primary care / Risk Factors / Risk Reduction Behavior / Statins / United States / Veterans