title: Adherence to guideline-recommended therapies among patients with diverse manifestations of vascular disease.
abstract: BACKGROUND
  Current guidelines recommend aspirin, statins, angiotensin-converting enzyme inhibitors (ACEIs), and smoking abstinence for all patients with vascular disease. There is little data on the variation in adherence to guideline-recommended therapies among patients with different clinical manifestations of vascular disease.
  
  
  OBJECTIVE
  To analyze the variation in adherence to guideline-recommended therapies among patients with diverse manifestations of vascular disease.
  
  
  METHODS
  We analyzed a comprehensive database of all patients with critical limb ischemia, claudication, acute limb ischemia, carotid artery stenosis, subclavian artery stenosis, renal artery stenosis, or mesenteric ischemia who underwent angiography between 2006 and 2013 at a multidisciplinary vascular center.
  
  
  RESULTS
  Among 1,114 patients with vascular disease, adherence to guideline-recommended therapy at time of angiography included use of aspirin in 936 (84%), statins in 753 (68%), ACEIs in 673 (60%), and smoking abstinence in 788 (71%). A total of 335 (30%) patients utilized all four guideline-recommended therapies. Adherence to four guideline-recommended therapies was lowest among patients with acute limb ischemia (14%) and highest among patients with renal artery stenosis (37%). Among all patients with vascular disease, the range of adherence to individual guidelines was 64%-91% for aspirin, 43%-83% for statins, 49%-66% for ACEIs, and 47%-78% for smoking abstention.
  
  
  CONCLUSIONS
  The majority of patients with diverse manifestations of vascular disease take aspirin and abstain from smoking while fewer patients are prescribed ACEIs and statins. Among the current recommendations, statins have the widest variation in adherence. Less than one-third of patients with diverse manifestations of vascular disease are prescribed all four guideline-recommended therapies.
authors.affiliation: Department of Internal Medicine, Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: Debbie C
authors.initials: DC
authors.lastname: Chen
authors.affiliation: Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.affiliation: Department of Internal Medicine, Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: Gagan D
authors.initials: GD
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: Ezra A
authors.initials: EA
authors.lastname: Amsterdam
authors.affiliation: Department of Internal Medicine, Vascular Center and Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Laird
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002140:California; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: peripheral arterial disease; secondary prevention; statin medications