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Comparative Study
. 2007 Mar;38(3):929-34.
doi: 10.1161/01.STR.0000257310.08310.0f. Epub 2007 Jan 25.

Suboptimal control of atherosclerotic disease risk factors after cardiac and cerebrovascular procedures

Eric M Cheng  1 , Steve M Asch, Robert H Brook, Stefanie D Vassar, Erin L Jacob, Martin L Lee, Donald S Chang, Ralph L Sacco, An-Fu Hsiao, Barbara G Vickrey
Affiliations
Comparative Study

Suboptimal control of atherosclerotic disease risk factors after cardiac and cerebrovascular procedures

Eric M Cheng et al. Stroke. 2007 Mar.

Erratum in

  • Stroke. 2007 Nov;38(11):e154

Abstract

Background and purpose: Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein.

Methods: Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (n=252), coronary artery bypass graft (n=486), or percutaneous coronary intervention (n=720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using chi(2) tests and multivariate logistic regression.

Results: The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure (P=0.05) compared with increases from 32% to 43% for coronary artery bypass graft (P=0.001) and from 29% to 45% for percutaneous coronary intervention (P=0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure (OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein (OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure (OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control.

Conclusions: Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients.

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