Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A veterans affairs study

Tarun W. Dasari, Harsh Golwala, Michael Koehler, Siddharth Wayangankar, Aneesh Pakala, Eliot Schechter, Pedro Lozano, Mazen S. Abu-Fadel, Faisal Latif, Udho Thadani

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD). METHODS: Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included. Demographic, clinical and treatment data were compared between the groups at baseline and 1 year. RESULTS: Of the 354 patients who underwent coronary angiography, 222 (63%) had follow-up data available at 12 ± 2 months. The mean age in the NOCAD (n = 119) and OCAD (n = 103) groups was similar. There was a lower prevalence of hypertension and heart failure (P < 0.05) in the NOCAD group. Compared with the OCAD group, aspirin use was similar but statin use was lower in the NOCAD group (P = 0.008). At 1 year, statin use (P = 0001) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P = 0.001) were significantly lower, whereas the use of aspirin was numerically lower (P = 0.06) in the NOCAD group. Mean low-density lipoprotein cholesterol levels were at goal (<100 mg/dL) in the NOCAD group at baseline and 1 year, whereas the same slightly worsened in the OCAD group at 1 year. CONCLUSIONS: The use of evidence-based medical therapy is lower in patients with NOCAD compared with those with OCAD. Improved awareness among health care providers and a unified effort to implement secondary prevention strategies may help correct such deficiencies.

Original languageEnglish (US)
Pages (from-to)339-342
Number of pages4
JournalAmerican Journal of the Medical Sciences
Volume345
Issue number5
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Fingerprint

Veterans
Coronary Artery Disease
Guidelines
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Secondary Prevention
Coronary Angiography
Aspirin
Angiotensin Receptor Antagonists
Therapeutics
Angiotensin-Converting Enzyme Inhibitors
Health Personnel
LDL Cholesterol
Angiography
Heart Failure
Demography
Hypertension

Keywords

  • Medical therapy
  • Nonobstructive coronary artery disease
  • Risk factors

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A veterans affairs study. / Dasari, Tarun W.; Golwala, Harsh; Koehler, Michael; Wayangankar, Siddharth; Pakala, Aneesh; Schechter, Eliot; Lozano, Pedro; Abu-Fadel, Mazen S.; Latif, Faisal; Thadani, Udho.

In: American Journal of the Medical Sciences, Vol. 345, No. 5, 01.01.2013, p. 339-342.

Research output: Contribution to journalArticle

Dasari, Tarun W. ; Golwala, Harsh ; Koehler, Michael ; Wayangankar, Siddharth ; Pakala, Aneesh ; Schechter, Eliot ; Lozano, Pedro ; Abu-Fadel, Mazen S. ; Latif, Faisal ; Thadani, Udho. / Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A veterans affairs study. In: American Journal of the Medical Sciences. 2013 ; Vol. 345, No. 5. pp. 339-342.
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AU - Dasari, Tarun W.

AU - Golwala, Harsh

AU - Koehler, Michael

AU - Wayangankar, Siddharth

AU - Pakala, Aneesh

AU - Schechter, Eliot

AU - Lozano, Pedro

AU - Abu-Fadel, Mazen S.

AU - Latif, Faisal

AU - Thadani, Udho

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N2 - BACKGROUND: Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD). METHODS: Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included. Demographic, clinical and treatment data were compared between the groups at baseline and 1 year. RESULTS: Of the 354 patients who underwent coronary angiography, 222 (63%) had follow-up data available at 12 ± 2 months. The mean age in the NOCAD (n = 119) and OCAD (n = 103) groups was similar. There was a lower prevalence of hypertension and heart failure (P < 0.05) in the NOCAD group. Compared with the OCAD group, aspirin use was similar but statin use was lower in the NOCAD group (P = 0.008). At 1 year, statin use (P = 0001) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P = 0.001) were significantly lower, whereas the use of aspirin was numerically lower (P = 0.06) in the NOCAD group. Mean low-density lipoprotein cholesterol levels were at goal (<100 mg/dL) in the NOCAD group at baseline and 1 year, whereas the same slightly worsened in the OCAD group at 1 year. CONCLUSIONS: The use of evidence-based medical therapy is lower in patients with NOCAD compared with those with OCAD. Improved awareness among health care providers and a unified effort to implement secondary prevention strategies may help correct such deficiencies.

AB - BACKGROUND: Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD). METHODS: Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included. Demographic, clinical and treatment data were compared between the groups at baseline and 1 year. RESULTS: Of the 354 patients who underwent coronary angiography, 222 (63%) had follow-up data available at 12 ± 2 months. The mean age in the NOCAD (n = 119) and OCAD (n = 103) groups was similar. There was a lower prevalence of hypertension and heart failure (P < 0.05) in the NOCAD group. Compared with the OCAD group, aspirin use was similar but statin use was lower in the NOCAD group (P = 0.008). At 1 year, statin use (P = 0001) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P = 0.001) were significantly lower, whereas the use of aspirin was numerically lower (P = 0.06) in the NOCAD group. Mean low-density lipoprotein cholesterol levels were at goal (<100 mg/dL) in the NOCAD group at baseline and 1 year, whereas the same slightly worsened in the OCAD group at 1 year. CONCLUSIONS: The use of evidence-based medical therapy is lower in patients with NOCAD compared with those with OCAD. Improved awareness among health care providers and a unified effort to implement secondary prevention strategies may help correct such deficiencies.

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