Pharmacological prevention of cardiac risk in claudicants with ischaemic heart disease.
BACKGROUND
Claudicants rarely progress to critical limb ischaemia but have a threefold increase in mortality, mainly due to cardiac disease. Antithrombotic therapy, beta blockers, ACE inhibitors and statins have been shown to reduce mortality and cardiovascular morbidity in patients with ischaemic heart disease.


OBJECTIVE
To investigate secondary pharmacological prevention of ischaemic heart disease in claudicants.


METHODS
We prospectively recorded comorbidity and drug treatment in 89 patients (67 men and 22 women) with a history of ischaemic heart disease recruited in a supervised exercise and lifestyle modification programme to improve claudication distance and prognosis.


RESULTS
Of the 89 cases, 40 had a history of angina only and 49 of myocardial infarction. Sixteen (18%) had diabetes, 47 (53%) had hypercholesterolaemia and 52 (58%) were hypertensive. Antithrombotic therapy was prescribed to 61 patients (68.5%), 64 (72%) with a history of myocardial infarction and 27 (67.5%) with angina only (p = 1). Beta-blockers were prescribed to 12 (13.5%) patients only, seven (15%) with a history of myocardial infarction and five (12.5%) with angina only (p = 1). Of the 47 patients with hypercholesterolaemia, 29 (62%) were on a statin.


CONCLUSIONS
Secondary pharmacological prevention of ischaemic heart disease in claudicants remains suboptimal, with only two thirds of patients receiving antithrombotic therapy and a small minority receiving beta blockers. Pharmacological prevention in claudicants should improve to reduce cardiac morbidity and mortality.
Torella
F
F
South Manchester University Hospital, Manchester, UK. FCMTDR@aol.com
Washington
S
S
Cooper
A
A
Parry
A D
AD
McCollum
C N
CN
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D015912:Thrombolytic Therapy
D000319:Adrenergic beta-Antagonists