title: Medical management of patients before the incidence of a cardiovascular event.
abstract: OBJECTIVE
  We sought to examine the diagnoses and medical management patterns of patients before the incidence of a cardiovascular (CV) event.
  
  
  METHODS
  A retrospective study of claims data from a national managed care plan was conducted. Eligible patients had a myocardial infarction, stroke, or revascularization between January 1, 2004 and December 31, 2005, and at least 3 years of continuous enrollment before the CV event. Patients were stratified by whether or not they had a diagnosis of atherosclerosis in the 3 years before the CV event. Diagnostic testing, lipid monitoring, and statin treatment patterns were assessed during the 3-year period before the CV event.
  
  
  RESULTS
  There were 16,543 patients with a CV event, and 65% had no previous diagnosis of atherosclerosis. For all patients, 58% were men, and mean age was 60 years. Angiography or cardiac imaging was performed in <3% of patients, and cardiac stress testing was performed in 13% of patients before the event. Only 19% of patients had ≥1 lipid test in the 12 months and 32% in the 3 years before the event, and their 12-month mean low-density lipoprotein cholesterol was 113 mg/dL. Thirty-four percent of patients were on statin therapy within the 3 years before event. The patient subgroup diagnosed with atherosclerosis had significantly more patients with cardiac testing, lipid monitoring, and statin therapy compared with patients with no previous diagnosis of atherosclerosis.
  
  
  CONCLUSIONS
  These results from an actual clinical practice dataset indicate opportunities for improved detection and management of underlying atherosclerotic heart disease to avoid future cardiovascular events.
authors.affiliation: Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Davidson
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Fox
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Gandhi
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: James M
authors.initials: JM
authors.lastname: McKenney