title: Suboptimal use of risk reduction therapy in peripheral arterial disease patients at a major teaching hospital.
abstract: OBJECTIVE
  Current evidence suggests that modification of atherosclerosis risk factors plays an important role in reducing adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). This study was undertaken to determine whether patients in this high-risk group were adequately using risk factor modification therapy.
  
  
  METHODS
  Prospective study of consecutive patients with PAD from a teaching hospital.
  
  
  METHODS
  The collected data included information about atherosclerotic risk factors and utilization of risk factor modification therapy
  
  
  RESULTS
  The 391 patients had a mean (standard deviation of 3 (1) atherosclerotic risk factors. Hypertension was identified in 56.8% of patients (222/391), of whom only 37.4% (83/222) had adequate blood pressure control (BP <140/90 mm Hg). The prevalence of diabetes mellitus (DM) was 35 % (137/391). Among patients with DM, only 49% (67/137) had adequate blood glucose control (glycosylated hemoglobin, HbA1c <7%). Statins were currently prescribed in 61% of patients (238/391), 38.7% (92/238) of whom continued to have low-density lipoprotein (LDL) >2.5 mmol/L, compared to a rate of 76.5% (117/153) among non-statin users (P<.001). The majority of patients of patients ( 72.4%; 283/391) were overweight/obese. Many patients (67.3%; 263/391) were nonsmokers; however, most (73.4%; 193/263) had a history of smoking. Antiplatelets were prescribed for 78.3% of patients (306/391), of whom 70.6% (216/306) were taking aspirin. Angiotensin converting enzyme (ACE) inhibitors were prescribed for 44.8% of patients (175/391). Among rampril users, only 36.8% of patients (53/144) were on an optimal dose.
  
  
  CONCLUSIONS
  Although atherosclerotic risk factors were prevalent in patients with PAD, we found that patients received sub-optimal use of risk reduction treatments. Effective strategies to encourage health professionals to use these adjunctive therapies need to be developed.
authors.affiliation: Toronto General Hospital, University of Toronto, Toronto, Canada. malomran@ksu.edu.sa
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Omran
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D050197:Atherosclerosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000209:etiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors