title: Cardiovascular medication in relation to renal function after coronary artery bypass surgery.
abstract: BACKGROUND
  Guidelines for recommended medication use for the secondary prevention of coronary heart disease are exceedingly important in patients with chronic kidney disease. Despite a high risk for recurrent cardiovascular events, these patients are less likely to use evidence-based recommended medications. The objective of the current study was to analyze the association between renal function and guideline-recommended drug therapy in patients with coronary heart disease.
  
  
  METHODS
  In this nationwide population-based cohort study, we included 12,332 patients with established coronary heart disease who underwent primary isolated coronary artery bypass grafting in Sweden between 2005 and 2008. Medication use was retrieved from the national Prescribed Drug Register.
  
  
  RESULTS
  During the first year after coronary surgery, 94% of patients had at least two dispensed prescriptions for an antiplatelet agent, 68% for an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 92% for a beta-blocker, and 93% for a statin. Only 57% of all patients had prescriptions for all four medication classes. Reduced renal function (estimated glomerular filtration rate (eGFR) of 30 to 45 mL/min per 1.73 m(2) and <30 mL/min per 1.73 m(2)) was significantly associated with a lower use of all four medication classes (adjusted risk ratio 0.89, 95% confidence interval 0.82 to 0.98; and adjusted risk ratio 0.75, 95% confidence interval 0.62 to 0.90, respectively) as compared to normal renal function (eGFR >60 mL/min per 1.73 m(2)).
  
  
  CONCLUSIONS
  In patients with established coronary heart disease, moderate to severe renal dysfunction was associated with significantly lower use of guideline-recommend medications as compared to normal renal function.
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: Ulrik.Sartipy@karolinska.se.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
authors.forename: Erik
authors.initials: E
authors.lastname: Rampell
authors.forename: Axel C
authors.initials: AC
authors.lastname: Carlsson
authors.forename: Per
authors.initials: P
authors.lastname: Wändell
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Holzmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000639:trends*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: CABG; Coronary artery disease; Pharmacoepidemiology; Renal dysfunction; Secondary prevention