How optimal is the medical management of patients prior to major reconstructive vascular surgery? The results of a cross-sectional study.
BACKGROUND
Risk factor modification is important in patients with vascular disease. Guidelines suggest that this patient population benefits from a medical regimen of antiplatelets, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.


METHODS
The medical regimen of consecutive patients who presented for major vascular surgery intervention over 18 months was examined.


RESULTS
Of the 325 patients identified, 176 (54%) were on antiplatelet treatment, 197 (61%) were on a statin, 180 (55%) on beta-blockers, and 146 (54%) on ACE inhibitors. A high-risk subset of 94 smokers with known coronary artery disease, hypertension, and hyperlipidemia or diabetes was identified. In this subset, patients were more likely to be on pharmacologic risk factor modification.


CONCLUSIONS
Despite recommendations, the pharmacologic risk factor modification of patients prior to vascular surgery remains suboptimal. Increased awareness of the problem and active participation of the vascular specialist are essential to improve compliance with established guidelines.
Marshall
Christy
C
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
Lin
Peter H
PH
Huynh
Tam T
TT
Kougias
Panagiotis
P
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001364:Awareness; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors