1. Observational study of the medical management of patients with peripheral artery disease
- Author
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David Sidloff, Jannick A N Dorresteijn, V Htun, Ruth A. Benson, Z Mera, Athanasios Saratzis, Brenig L. Gwilym, R Lefroy, David C. Bosanquet, Toby Richards, Frank L.J. Visseren, A Tsui, A Thatcher, George Dovell, Nikesh Dattani, M Parks, N E M Jaspers, Rachael O. Forsythe, O Thomas, Joseph Shalhoub, and Tristan R A Lane
- Subjects
Male ,medicine.medical_specialty ,Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ,Platelet Aggregation Inhibitors/therapeutic use ,Blood Pressure ,030204 cardiovascular system & hematology ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Journal Article ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Cardiovascular Diseases/etiology ,Risk factor ,Prospective cohort study ,11 Medical and Health Sciences ,Aged ,Aspirin ,Lipids/blood ,business.industry ,Absolute risk reduction ,Guideline ,Middle Aged ,Guideline Adherence/statistics & numerical data ,Lipids ,United Kingdom ,Blood pressure ,Cardiovascular Diseases ,Cohort ,Peripheral Arterial Disease/complications ,Female ,Smoking Cessation ,Surgery ,Guideline Adherence ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Vascular and Endovascular Research Network (VERN) Collaborators ,business ,Risk Reduction Behavior ,Platelet Aggregation Inhibitors ,Fibrinolytic agent ,medicine.drug - Abstract
Background Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification. Methods The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. Results Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44–62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20–38) per cent with 6·3 (4·0–9·3) cardiovascular disease-free years gained. Conclusion The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.
- Published
- 2019