title: Is risk factor control and guideline-based medical therapy optimal in patients with nonobstructive coronary artery disease? A Veterans Affairs study.
abstract: BACKGROUND
  Aggressive risk factor modification using evidence-based secondary prevention strategies is recommended in coronary artery disease (CAD). Utilization of such strategies was compared in patients with nonobstructive CAD (NOCAD) and obstructive CAD (OCAD).
  
  
  METHODS
  Patients undergoing coronary angiography (excluding normal coronary angiograms), between January 2006 and June 2006, at the Veterans Affairs Medical Center were included. Demographic, clinical and treatment data were compared between the groups at baseline and 1 year.
  
  
  RESULTS
  Of the 354 patients who underwent coronary angiography, 222 (63%) had follow-up data available at 12 ± 2 months. The mean age in the NOCAD (n = 119) and OCAD (n = 103) groups was similar. There was a lower prevalence of hypertension and heart failure (P < 0.05) in the NOCAD group. Compared with the OCAD group, aspirin use was similar but statin use was lower in the NOCAD group (P = 0.008). At 1 year, statin use (P = 0001) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P = 0.001) were significantly lower, whereas the use of aspirin was numerically lower (P = 0.06) in the NOCAD group. Mean low-density lipoprotein cholesterol levels were at goal (<100 mg/dL) in the NOCAD group at baseline and 1 year, whereas the same slightly worsened in the OCAD group at 1 year.
  
  
  CONCLUSIONS
  The use of evidence-based medical therapy is lower in patients with NOCAD compared with those with OCAD. Improved awareness among health care providers and a unified effort to implement secondary prevention strategies may help correct such deficiencies.
authors.affiliation: Department of Internal Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. dasaritarun@gmail.com
authors.forename: Tarun W
authors.initials: TW
authors.lastname: Dasari
authors.forename: Harsh
authors.initials: H
authors.lastname: Golwala
authors.forename: Michael
authors.initials: M
authors.lastname: Koehler
authors.forename: Siddharth
authors.initials: S
authors.lastname: Wayangankar
authors.forename: Aneesh
authors.initials: A
authors.lastname: Pakala
authors.forename: Eliot
authors.initials: E
authors.lastname: Schechter
authors.forename: Pedro
authors.initials: P
authors.lastname: Lozano
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Abu-Fadel
authors.forename: Faisal
authors.initials: F
authors.lastname: Latif
authors.forename: Udho
authors.initials: U
authors.lastname: Thadani
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans