Only a minority of patients referred for elective coronary artery bypass surgery have risk factors diagnosed and treated according to established guidelines.
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.
Anderson
Russell E
RE
Section for Cardiothoracic Surgery and Anaesthesiology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. russell.anderson@ki.se
Brismar
Kerstin
K
Ivert
Torbjörn
T
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
D000959:Antihypertensive Agents; D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids