Document Detail


Suboptimal control of atherosclerotic disease risk factors after cardiac and cerebrovascular procedures.
MedLine Citation:
PMID:  17255549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Eric M Cheng; 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
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-01-25
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  38     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-27     Completed Date:  2007-03-19     Revised Date:  2007-10-30    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  929-34     Citation Subset:  IM    
Affiliation:
Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. eric.cheng@va.gov
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Atherosclerosis / blood,  epidemiology*,  prevention & control
Cholesterol, LDL / blood
Coronary Artery Bypass*
Databases, Factual
Endarterectomy, Carotid*
Female
Hospitals, Veterans
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Chemical
Reg. No./Substance:
0/Cholesterol, LDL
Comments/Corrections
Erratum In:
Stroke. 2007 Nov;38(11):e154

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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