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Observational study of the medical management of patients with peripheral artery disease
- Source :
- British Journal of Surgery, 106(9), 1168. John Wiley and Sons Ltd, 2019, ' Observational study of the medical management of patients with peripheral artery disease ', British Journal of Surgery, vol. 106, no. 9, pp. 1168-1177 . https://doi.org/10.1002/bjs.11214
- Publication Year :
- 2019
- Publisher :
- Oxford University Press (OUP), 2019.
-
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.
- 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
Subjects
Details
- ISSN :
- 13652168 and 00071323
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- British Journal of Surgery
- Accession number :
- edsair.doi.dedup.....224abf4f8e1dcd8eb3a3b1e3ccc30d1b