Secondary prevention in coronary artery disease patients in South Auckland: moving targets and the current treatment gap

Abstract

Aim: To assess secondary prevention parameters in patients with coronary artery disease (CAD) and correlate them with evolving treatment targets.

Methods: We audited baseline and current secondary prevention parameters in consecutive patients with established CAD who were identified retrospectively after an acute coronary syndrome (n = 48), recent coronary artery bypass grafting (CABG, n = 50), or remote CABG (n = 49).

Results: Statins were used by 71% of the whole group and 80% of those whose total cholesterol (TC) levels exceeded the contemporaneous PHARMAC cut-off point for statin funding. Thirty seven per cent failed to achieve the New Zealand Heart Foundation (NZHF) target TC of 3-5 mmol/l current at the time, and 55% exceeded the National Cholesterol Education Programme and 2002 NZHF Interim Consensus Statement target of low density lipoprotein (LDL) <2.6 mmol/l. Forty one per cent had a blood pressure (BP) of >140/90 mmHg, 12% were smokers and 7% not on aspirin. A minority of patients were on ACE inhibitors (34%) and beta blockers (45%). Only 30% were non-smokers, on aspirin and met TC and BP targets.

Conclusions: Risk-factor management is sub-optimal in a significant percentage of secondary prevention patients. Improved statin availability in New Zealand subsequent to this audit creates the opportunity to reduce the treatment gap.