Secondary prevention in coronary artery disease patients in South Auckland: moving targets and the current treatment gap.
OBJECTIVE
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.
El-Jack
Seifeddin
S
Cardiology Department, Middlemore Hospital, Auckland, New Zealand.
Kerr
Andrew
A
D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000517:prevention & control*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy; D008055:Lipids / Q000097:blood; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D009520:New Zealand; D012307:Risk Factors; D012907:Smoking
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids