title: Three Decades of Atherosclerotic Reno-vascular Disease Management - Changing Outcomes in an Observational Study.
abstract: OBJECTIVE
  Optimized medical therapy has improved cardiovascular outcomes in the general population. To investigate whether changes in the management of atherosclerotic renovascular disease (ARVD) have had an impact on clinical outcomes.
  
  
  METHODS
  Recruitment into this single-center prospective cohort study started in 1986. Data was analyzed retrospectively. Patients were divided into four groups based on relationship of diagnosis year to landmark randomized controlled trials (RCT); group 1 - pre-large RCT data (1986-2000); group 2 - post-early RCT (2001-2004); group 3 - ASTRAL study recruitment era (2004-2009); group 4 - post-ASTRAL (2009-2014).
  
  
  RESULTS
  In total, 872 patients were followed for a median 54.9 months (IQR 20.2-96.2). Over successive time-periods, there was an increase in baseline utilization of renin angiotensin blockade (RAB) (group 4: 69% vs. group 1: 31%, p<0.001), statins (74% vs 20%, p<0.001) and beta-blockers (43% vs 30%, p=0.024). Median time to death, end-stage kidney disease and cardiovascular events improved except in group 4, which displayed more baseline cardiovascular comorbidities. The number of investigative angiograms performed decreased from 139 per year between 2006 and 2008 to 74 per year in group 4.
  
  
  CONCLUSIONS
  Although fewer patients are being investigated for ARVD in our center, these have more cardiovascular comorbidities. Nonetheless, optimized medical therapy may have contributed towards improved proteinuria, renal function and clinical outcomes in patients diagnosed with ARVD.
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors.forename: Diana
authors.initials: D
authors.lastname: Vassallo
authors.forename: Darren
authors.initials: D
authors.lastname: Green
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.forename: Constantina
authors.initials: C
authors.lastname: Chrysochou
authors.forename: James
authors.initials: J
authors.lastname: Blunt
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D050197:Atherosclerosis / Q000188:drug therapy* / Q000401:mortality; D002318:Cardiovascular Diseases; D015331:Cohort Studies; D015897:Comorbidity; D019468:Disease Management; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012078:Renal Artery Obstruction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome