title: Reduction in atherosclerotic events: a retrospective study in an outpatient cardiology practice.
abstract: BACKGROUND
  Although atherosclerotic disease cannot be cured, risk of recurrent events can be reduced by application of evidence-based treatment protocols involving aspirin, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statin medications. We studied atherosclerotic event rates in a patient population treated before and after the development of aggressive risk factor reduction treatment protocols.
  
  
  METHODS
  We performed a retrospective chart review of patients presenting for follow-up treatment of coronary artery disease in a community cardiology practice, comparing atherosclerotic event rates and medication usage in a 2-year treatment period prior to 2002 and a 2-year period in 2005-2008. Care was provided in both the early and later eras by 7 board-certified cardiologists in a suburban cardiology practice. Medication usage was compared in both treatment eras. The primary outcome was a composite event rate of myocardial infarction, cerebrovascular events, and coronary interventions.
  
  
  RESULTS
  Three hundred and fifty-seven patients were studied, with a follow-up duration of 12.1 (±3.5) years. There were 132 composite events in 104 patients (29.1%) in the early era compared to 40 events in 33 patients (9.2%) in the later era (p < 0.0001). From the early to the later eras, there was an increase in use of β-blockers (66% to 83%, p < 0.0001), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (34% to 80%, p < 0.0001), and statins (40% to 90%, p < 0.0001).
  
  
  CONCLUSIONS
  Application of aggressive evidence-based medication protocols for treatment of atherosclerosis is associated with a significant decrease in atherosclerotic events or need for coronary intervention.
authors.affiliation: Westchester Cardiology Associates/WestMed Medical Group and Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Mercando
authors.forename: Hoang M
authors.initials: HM
authors.lastname: Lai
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Phoenix
authors.initials: P
authors.lastname: Kalen
authors.forename: Harit V
authors.initials: HV
authors.lastname: Desai
authors.forename: Kaushang
authors.initials: K
authors.lastname: Gandhi
authors.forename: Mala
authors.initials: M
authors.lastname: Sharma
authors.forename: Harshad
authors.initials: H
authors.lastname: Amin
authors.forename: Trung M
authors.initials: TM
authors.lastname: Lai