[Management of the cardiology patient with polyvascular disease: PRISMA study].
BACKGROUND
Myocardial infarction (MI), peripheral vascular disease and ischaemic cerebral vascular accident (CVA) are three manifestations of the same disease, atherothrombosis, and they share the same pathophysiology and prognosis.


OBJECTIVE
The aim of this work was to describe the clinical characteristics and the medical management of polyvascular patients in cardiology.


METHODS
Cardiologists from all over the country participated in a consultation register for 3 weeks. The clinical characteristics and medical management for the first 3 patients on the register for each cardiologist were studied in a national multicentre study and then compared according to whether the atherothrombotic disease was isolated or polyvascular.


RESULTS
In total, 100,429 patients were examined during the period of the register and 2,780 were included in the study. Polyvascular patients represented 7% of the register and 22% of the vascular patients. These patients with multiple manifestations were frequently diabetics. A lipid profile was available less often in the cardiac patients when they had another disorder (72.4%) than in the case of an isolated disorder (78.9%). Whatever the initial disorder, dyslipidaemia was less often controlled in the case of polyvascular disease (63% of LDL-C > or = 1.3g/l in polyvascular cardiac patients vs 52% in cardiac patients with isolated disease). In cardiac patients, the presence of peripheral vascular disease was associated with less prescription of beta blockers (OR=0.4 [0.3-0.6]), the presence of CVA was associated with less prescription of statins (OR=0.7 [0.5-0.9]). Eight out of 10 polyvascular patients received anti-platelet aggregation treatment. The presence of multiple atherothrombotic manifestations was associated with greater prescription of ACEI, except in cardiac patients.


CONCLUSIONS
These results improve our understanding of the specific management of polyvascular patients, for whom secondary prevention is paramount due to the higher risk of recurrence. They should prompt the reinforcement of measures which have been shown to be effective, such as managing major risk factors, and in particular the dislipidaemias.
Cournot
M
M
INSERM U5558, Département d'épidémiologie, Faculté de médecine, Toulouse.
Cambou
J P
JP
Ferrières
J
J
Grenier
O
O
Herrmann
M A
MA
Cantet
C
C
Leizorovicz
A
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors