Preventive therapy in patients with insignificantly narrowed coronary arteries: evaluation of physician attitude and practice.
BACKGROUND
Although the outcome of patients with angiographically insignificantly narrowed coronary arteries (INCA) is not clearly defined, such lesions can progress or rupture, thus causing cardiovascular morbidity. Preventive therapy with aspirin and lipid-lowering drugs therefore seems warranted in these patients.


OBJECTIVE
The study was undertaken to evaluate the attitude and practice of physicians toward the provision of preventive treatment to patients with INCA.


METHODS
The attitude of physicians was evaluated using written case histories of three patients with identical clinical features but different angiographic diagnoses. We then examined randomly chosen files of 130 patients with angiographically normal coronary arteries, 130 patients with INCA, and 130 patients with significant coronary artery disease, in relation to the use of lipid-lowering medications and achieved lipoprotein levels.


RESULTS
For the hypothetical patients, more physicians prescribed statins (78 vs. 47%, p<0.0001) and aspirin (89 vs. 74%, p<0.003) for patients with significant disease than they did for those with INCA. A target low-density lipoprotein (LDL) cholesterol of < 100 mg/dl was considered appropriate for significant disease by 85% of physicians compared with 40% for INCA (p<0.0001). In the real patients, more of those with significant disease received lipid-lowering drugs and achieved the LDL target level than did those with INCA.


CONCLUSIONS
Many physicians regard the need to prescribe preventive treatment as less important for patients with INCA than for patients with significant coronary disease. Additional long-term studies are warranted to elucidate the prognostic significance of INCA and the efficacy of preventive therapy in these patients.
Henkin
Yaakov
Y
Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel. yaakovh@bgumail.bgu.ac.il
Abuful
Akram
A
Yosefi
Chaim
C
Elis
Avishay
A
Ilia
Reuven
R
Gidron
Yori
Y
D000328:Adult; D001241:Aspirin / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003327:Coronary Disease / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000473:pathology*; D018450:Disease Progression; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007557:Israel; D008297:Male; D011292:Premedication / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment; D011795:Surveys and Questionnaires
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin