title: Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease.
abstract: BACKGROUND
  In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome.
  
  
  OBJECTIVE
  To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD.
  
  
  METHODS
  We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing.
  
  
  RESULTS
  The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042).
  
  
  CONCLUSIONS
  Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.
authors: Polyclinique du Bois, Lille, France.
authors: Thibaud
authors: T
authors: Meurice
authors: Centre Hospitalier de Dunkerque, Dunkerque, France.
authors: Olivier
authors: O
authors: Tricot
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
authors: Gilles
authors: G
authors: Lemesle
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
authors: Michel
authors: M
authors: Deneve
authors: Polyclinique de Riaumont, Lievin, France.
authors: Philippe
authors: P
authors: Lejeune
authors: Centre Hospitalier de Lens, Lens, France.
authors: Frédéric
authors: F
authors: Biausque
authors: Centre Hospitalier de Seclin, Seclin, France.
authors: Christophe
authors: C
authors: Cordier
authors: Polyclinique du Bois, Lille, France.
authors: Christine
authors: C
authors: Savoye
authors: Medical Office, Templemars, France.
authors: Olivier
authors: O
authors: Hennebert
authors: Medical Office, Somain, France.
authors: Kouroch
authors: K
authors: Taghipour
authors: Centre Hospitalier de Wattrelos, Wattrelos, France.
authors: Bruno
authors: B
authors: Sivery
authors: Clinique des Acacias, Cucq, France.
authors: Philippe
authors: P
authors: Pruvost
authors: Centre Hospitalier de Boulogne-sur-mer, Boulogne-sur-mer, France.
authors: Moulay
authors: M
authors: Alaoui
authors: Medical Office, Henin Beaumont, France.
authors: Laurent
authors: L
authors: Carpentier
authors: Centre Hospitalier de Lens, Lens, France.
authors: Benoit
authors: B
authors: Segrestin
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
authors: Nicolas
authors: N
authors: Lamblin
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France. Electronic address: christophe.bauters@chru-lille.fr.
authors: Christophe
authors: C
authors: Bauters
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015897:Comorbidity; D003327:Coronary Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005602:France; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents
keywords: Angiotensin-converting enzyme inhibitor; Antiplaquettaire; Antiplatelet; Beta-blocker; Inhibiteur de l’enzyme de conversion de l’angiotensine; Prevention; Prévention; Statin; Statine; ß-bloquant