title: Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease.
abstract: BACKGROUND
  Guidelines recommend that patients with peripheral arterial disease should be medically treated to reduce the occurrence of serious cardiovascular events. Despite these recommendations, studies conducted in the early 2000s reported that medical therapies for secondary cardiovascular prevention are not given systematically to patients with peripheral arterial disease (PAD). We identified factors associated with the prescription of preventive therapies in patients with symptomatic PAD.
  
  
  RESULTS
  Consecutive patients with symptomatic peripheral arterial disease (n = 362) treated between 2008 and 2010 in one tertiary care center (CHU de Quebec, Canada) were considered. Data were collected from the medical charts. The main outcome was the combined prescription of three therapies: 1) statins, 2) antiplatelets, 3) angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. The mean age was 70 years and 43% had a pre-existing coronary artery disease. Antiplatelet therapy was the most prescribed drug (83%). A total of 52% of the patients received the three combined therapies. Less than 10% of patients had a known contraindication to one class of medication. Having at least three cardiovascular risk factors (Odds Ratio (OR) = 4.51; 95% CI: 2.76-7.37) was the factor most strongly associated with the prescription of the combined therapies. Pre-existing coronary artery disease (OR = 2.28; 95% CI: 1.43-3.65) and history of peripheral vascular surgery (OR = 2.30; 95% CI: 1.37-3.86) were two factors independently associated with the prescription of the combined therapies. However, peripheral arterial disease patients with chronic critical limb ischemia were less likely to receive the combined therapies (OR = 0.53; 95% CI: 0.32-0.87) than those with claudication. The retrospective nature of this study, not allowing for an exhaustive report of the contraindication to medication prescription, is the main limitation.
  
  
  CONCLUSIONS
  About half of the patients with peripheral arterial disease were not optimally managed. Patients with multiple cardiovascular risk factors were more likely to receive the combined therapies. We still need to better understand the barriers and facilitators to the application of the guidelines.
authors: Department of Vascular Surgery, Centre Hospitalier Universitaire de Québec, Quebec, Canada.|Research Center of the Centre Hospitalier Universitaire de Québec, Quebec, Canada.
authors: Myriam L
authors: ML
authors: Montminy
authors: Department of Vascular Surgery, Centre Hospitalier Universitaire de Québec, Quebec, Canada.
authors: Valerie
authors: V
authors: Gauvin
authors: Research Center of the Centre Hospitalier Universitaire de Québec, Quebec, Canada.
authors: Stephane
authors: S
authors: Turcotte
authors: Department of Vascular Medicine, Centre Hospitalier Universitaire de Québec, Canada.
authors: Alain
authors: A
authors: Milot
authors: Department of Vascular Surgery, Centre Hospitalier Universitaire de Québec, Quebec, Canada.
authors: Yvan
authors: Y
authors: Douville
authors: Public Health Department, Centre Hospitalier Universitaire de Québec, Québec, Canada.
authors: Isabelle
authors: I
authors: Bairati
mesh_terms: D000368:Aged; D017130:Angioplasty; D003131:Combined Modality Therapy; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000188:drug therapy* / Q000628:therapy; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors