title: Only a minority of patients referred for elective coronary artery bypass surgery have risk factors diagnosed and treated according to established guidelines.
abstract: Patients deserve to be medically optimised for treatment of metabolic risk factors and hypertension before referral for elective coronary artery bypass grafting (CABG). We describe here a prospective study of 347 consecutive patients referred for elective CABG. An oral glucose tolerance test (OGTT) was performed and metabolic risk factors and hypertension were determined pre-operatively. Compliance to treatment guidelines was calculated. From the total of 347 patients, 80 patients (23%) had known and 66 (19%) had previously unknown diabetes. Dysglycaemia (that is, diabetes and pre-diabetes) was found in 194 (73%) of the 267 patients without known diabetes. Among patients with dysglycaemia, 111/274 (41%) received one antihypertensive medication, or none, and blood pressure guidelines were met in 39/274 (14%); statins were being taken by 206 (75%; average dose 23 mg simvastatin) and low-density lipoprotein (LDL)-cholesterol guidelines were met in 43 (16%). In conclusion, diabetes diagnosis and titration of risk factor treatment to guidelines is inadequate even in elective CABG patients. A pre-admission OGTT affords an opportunity to improve care significantly.
authors.affiliation: Section for Cardiothoracic Surgery and Anaesthesiology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. russell.anderson@ki.se
authors.forename: Russell E
authors.initials: RE
authors.lastname: Anderson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Ivert
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001786:Blood Glucose; D001794:Blood Pressure / Q000187:drug effects; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D017558:Elective Surgical Procedures; D005260:Female; D005951:Glucose Tolerance Test; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids