Protective vascular treatment of patients with peripheral arterial disease: guideline adherence according to year, age and gender.
OBJECTIVE
To evaluate vasoprotective pharmacological treatment of patients with peripheral arterial disease (PAD) according to: 1) year, 2) age and 3) gender.


METHODS
An observational retrospective study was conducted to evaluate the systemic vascular treatment of a population-based cohort of patients with PAD > or = 50 years old, discharged from a tertiary-care teaching hospital between January 1, 1997 and December 11, 2006. Data were obtained from the Régie de l'assurance maladie du Québec. Drugs evaluated included antiplatelet agents (APs), statins (STs) and angiotensin converting enzyme inhibitors (ACEIs), and a combination of all three. Proportions of patients treated were compared according to year, age and gender using Chi-square.


RESULTS
The mean age of the study population (5962 individuals) was 73.2 +/- 9.1 years; 43.8% were women. After hospital discharge, 71.6%, 47.6%, 42.2% and 20.6% were taking respectively, an AP, statin, ACEI or all three. Protective treatment improved significantly from 1997 to 2006. Significantly more subjects 50-64 years used a statin or all three agents, compared to subjects > or = 65 years (statins: 56.6% vs. 45.8%, all three: 26.2% vs. 19.5%; p < 0.001). Significantly more men than women used statins (49.1% vs. 45.6%; p < 0.001) and ACEIs (44.5% vs. 39.3%; p < 0.001). Similarily, use of all three agents was 22.4% for men and 18.2% for women (p < 0.001).


CONCLUSIONS
Although systemic vascular treatment received by patients with PAD has increased in the past years, it remains suboptimal, particularly for older patients and women. Strategies to improve adherence to treatment guidelines should be developed for these high-risk populations.
Pâquet
Mariane
M
Centre de recherche sur le vieillissement, Institut universitaire de gériatrie de Sherbrooke, Sherbrooke, QC. mariane.paquet@usherbrooke.ca
Pilon
Danielle
D
Tétrault
Jean-Pierre
JP
Carrier
Nathalie
N
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015415:Biomarkers; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011792:Quebec; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012737:Sex Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors