Patients with abdominal aortic aneurysm: are we missing the opportunity for cardiovascular risk reduction?
BACKGROUND
Antiplatelet agents, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statin drugs), angiotensin converting enzyme (ACE) inhibitors, and beta-adrenergic receptor blockers (beta-blockers) reduce cardiovascular risk and mortality in patients with specific manifestations of cardiovascular disease and risk factors. Occlusive arterial disease, in particular, coronary heart disease, is prevalent in patients with abdominal aortic aneurysm (AAA) and results in reduced life expectancy. The purpose of this study was to investigate the prevalence of cardiovascular disease and risk factors in patients with AAA. In particular, numbers of patients in whom pharmacologic therapy is indicated and numbers of patients who are receiving adequate treatment were determined.


METHODS
This was a prospective study of 313 patients with AAA in Leicestershire over the 15 months between September 2002 and December 2003.


RESULTS
Data that enabled determination of an indication for antiplatelet agents and statin drugs were available for 262 patients (84%), and for a beta-blocker and ACE inhibitor for 313 patients (100%). An antiplatelet agent was indicated in 242 of 262 patients (92%), a statin drug was indicated in 196 of 262 patients (75%), a beta-blocker was indicated in 107 of 313 patients (34%), and an ACE inhibitor was indicated in 178 of 313 patients (57%). In patients with an indication, 146 of 242 patients (60%) were using an antiplatelet agent, 81 of 196 (41%) were using a statin drug, 41 of 313 (38%) were using a beta-blocker, and 69 of 313 (39%) were using an ACE inhibitor.


CONCLUSIONS
Cardiovascular disease, for which there is evidence for the survival benefit of pharmacologic risk reduction, is prevalent in patients with AAA. The data show that current treatment of cardiovascular risk is suboptimal and could be improved, with an expected reduction in cardiovascular morbidity and mortality.
Department of Surgery, Leicester Royal Infirmary, England. geraint_l@hotmail.com
G M
GM
Lloyd
J D
JD
Newton
M G A
MG
Norwood
S C
SC
Franks
M J
MJ
Bown
R D
RD
Sayers
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors