title: Achievement of optimal medical therapy goals for U.S. adults with coronary artery disease: results from the REGARDS Study (REasons for Geographic And Racial Differences in Stroke).
abstract: OBJECTIVE
  In a nonclinical trial setting, we sought to determine the proportion of individuals with coronary artery disease (CAD) with optimal risk factor levels based on the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation) trial.
  
  
  BACKGROUND
  In the COURAGE trial, the addition of percutaneous coronary intervention (PCI) to optimal medical therapy did not reduce the risk of death or myocardial infarction in stable CAD patients but resulted in more revascularization procedures.
  
  
  METHODS
  The REGARDS (REasons for Geographic And Racial Differences in Stroke) study is a national prospective cohort study of 30,239 African-American and white community-dwelling individuals older than 45 years of age who enrolled in 2003 through 2007. We calculated the proportion of 3,167 participants with self-reported CAD meeting 7 risk factor goals based on the COURAGE trial: 1) aspirin use; 2) systolic blood pressure <130 mm Hg and diastolic blood pressure <85 mm Hg (<80 mm Hg if diabetic); 3) low-density lipoprotein cholesterol <85 mg/dl, high-density lipoprotein cholesterol >40 mg/dl, and triglycerides <150 mg/dl; 4) fasting glucose <126 mg/dl; 5) nonsmoking status; 6) body mass index <25 kg/m(2); and 7) exercise ≥4 days per week.
  
  
  RESULTS
  The mean age of participants was 69 ± 9 years; 33% were African American and 35% were female. Overall, the median number of goals met was 4. Less than one-fourth met ≥5 of the 7 goals, and 16% met all 3 goals for aspirin, blood pressure, and low-density lipoprotein cholesterol. Older age, white race, higher income, more education, and higher physical functioning were independently associated with meeting more goals.
  
  
  CONCLUSIONS
  There is substantial room for improvement in risk factor reduction among U.S. individuals with CAD.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: tmbrown@uab.edu.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Brown
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jenifer H
authors.initials: JH
authors.lastname: Voeks
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David A
authors.initials: DA
authors.lastname: Brenner
authors.affiliation: Department of Medicine, University of Vermont, Burlington, Vermont.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Colorado School of Public Health, Aurora, Colorado.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Stephen
authors.initials: S
authors.lastname: Glasser
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Huntsville Hospital, Huntsville, Alabama.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Tabereaux
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000208:ethnology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D044469:Racial Groups; D020521:Stroke / Q000208:ethnology* / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: coronary artery disease; prevention; risk factors