After acute coronary syndrome, diabetic patients with peripheral vascular disease remain at high risk of cardiovascular events despite secondary prevention measures.
BACKGROUND
Peripheral vascular disease (PVD) is associated with a high risk of cardiovascular events after an acute coronary syndrome (ACS). The impact of suboptimal risk-factor control and drug prescription on morbidity and mortality rates in patients with PVD following an ACS remains to be established.


OBJECTIVE
To assess whether a global atherosclerosis management programme and optimal secondary prevention could benefit high-risk PVD patients after an ACS.


METHODS
A total of 851 ACS patients underwent an intensified intervention focusing on evaluating risk factors and atherosclerosis lesions, and on optimizing treatment and education. We compared its impact on long-term risk factors, medication observance and cardiovascular outcomes in patients with coronary artery disease (CAD) alone (n=715, 84.0%) and with both CAD and PVD (n=136).


RESULTS
At a median follow-up of 18.6months, both groups reached recommended secondary prevention goals and showed no significant differences in rates of drug prescription. PVD was not associated with minor cardiovascular events (hazard ratio [HR] 1.32, 95% confidence interval [CI] 0.57-3.02) but remained independently associated with major (HR 2.15, 95% CI 1.12-4.13) and total (HR 1.76, 95% CI 1.05-2.93) cardiovascular events. Compared to patients with CAD alone, this risk was significantly higher in CAD patients with both PVD and diabetes (HR 2.87, 95% CI 1.52-5.43), but not in PVD patients without diabetes (HR 1.35, 95% CI 0.71-2.56) or diabetic patients without PVD (HR 1.11, 95% CI 0.68-1.81).


CONCLUSIONS
Despite optimization of risk-factor control and drug prescription after ACS, patients with both PVD and diabetes carry a 2.9-fold higher risk of cardiovascular events at 18-month follow-up versus patients with CAD alone. This excess risk was not significant in PVD patients without diabetes or in diabetic patients without PVD.
Lafitte
Marianne
M
CEPTA, hôpital cardiologique, CHU Haut-Levêque, avenue de Magellan, 33604 Pessac cedex, France. marianne_lafitte@hotmail.com <marianne_lafitte@hotmail.com>
Barandon
Laurent
L
Pucheu
Yann
Y
Pillois
Xavier
X
Gin
Henri
H
Bonnet
Jacques
J
Couffinhal
Thierry
T
D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011307:Drug Prescriptions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents