130224s in preventive medical therapies and CV risk factors after CT angiography.
- 2013
BACKGROUND: The relationship of CTA findings to subsequent 130224s in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown. CONCLUSIONS: CAD presence and severity on CTA are associated with increased use of preventive cardiovascular medications and improvements in cholesterol and BP. Copyright 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: We studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (<50%), or obstructive (>50%). Prescriptions were queried in the 6 months pre- and post-CTA for comparison of aspirin, statin, and BP treatment. Medication intensification was defined as initiation, dose increase, or, for statins, 130224 to a more potent formulation. Lipid and BP values were obtained at 12 months pre- and post-CTA. OBJECTIVES: The aim of the study was to determine the association of coronary computed tomographic angiography (CTA)-identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and 130224s in cholesterol and blood pressure (BP). RESULTS: Patients were 50 + 12 years of age (59% men), with 34%, 47%, and 33% on baseline statin, BP medication(s), and aspirin, respectively. Relative to patients without CAD (n = 617), patients with nonobstructive (n = 411) and obstructive CAD (n = 97) demonstrated significant intensification in unadjusted rates of statin (26%, 46%, and 46% of patients; p < 0.001), BP (11%, 21%, and 24%; p < 0.001), and aspirin therapies (9%, 29%, and 40%; p < 0.001), and significant improvements in total cholesterol (-6.7, -14.7, and -24.7 mg/dl; p = 0.008), low-density lipoprotein cholesterol (-5.6, -14.1, and -24.6 mg/dl; p = 0.001), systolic (+0.1, -1.4, and -4.9 mm Hg; p = 0.002), and diastolic BP (-0.6, -1.0, and -3.4 mm Hg; p = 0.012), respectively. Adjusted for baseline risk factors and medications, CAD was independently associated with increased aspirin, statin, and BP medication use rates in CTA-identified nonobstructive CAD (odds ratio [OR]: 6.9, 95% confidence interval [CI]: 4.7 to 10.2; OR: 6.6, 95% CI: 3.0 to 14.3; OR: 1.6, 95% CI: 1.1 to 2.2, respectively; p < 0.05), and aspirin and statin use in obstructive CAD (OR: 42.4, 95% CI: 15.8 to 113.9; OR: 30.3, 95% CI: 3.2 to 289.2, respectively; p < 0.05).
English
*Coronary Angiography/mt [Methods] *Coronary Artery Disease/ra [Radiography] *Coronary Artery Disease/th [Therapy] *Decision Support Techniques *Physician's Practice Patterns *Preventive Health Services *Tomography, X-Ray Computed Adult Aged Antihypertensive Agents/tu [Therapeutic Use] Aspirin/tu [Therapeutic Use] Biological Markers/bl [Blood] Blood Pressure/de [Drug Effects] Chi-Square Distribution Cholesterol/bl [Blood] Coronary Artery Disease/bl [Blood] Coronary Artery Disease/pp [Physiopathology] Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use] Linear Models Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Platelet Aggregation Inhibitors/tu [Therapeutic Use] Predictive Value of Tests Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index Treatment Outcome