title: Risk Factor Optimization and Guideline-Directed Medical Therapy in US Veterans With Peripheral Arterial and Ischemic Cerebrovascular Disease Compared to Veterans With Coronary Heart Disease.
abstract: Cardiovascular disease (CVD) is a systemic process involving multiple vascular beds and includes coronary heart disease (CHD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). All these manifestations are associated with an increased risk of subsequent myocardial infarction, stroke, and death. Guideline-directed medical therapy is recommended for all patients with CVD. In a cohort of US veterans, we identified 1,242,015 patients with CVD receiving care in 130 Veterans Affairs facilities from October 1, 2013 to September 30, 2014. CVD included diagnoses of CHD, PAD, or ICVD. We assessed the frequency of risk factor optimization and the use of guideline-directed medical therapy in patients with CHD, PAD alone, ICVD alone, and PAD + ICVD groups. A composite of 4 measures (blood pressure <140/90 mm Hg, A1c <7% in diabetics, statin use, and antiplatelet use in eligible patients), termed optimal medical therapy (OMT) was compared among groups. Multivariate logistic regression was performed with CHD as the referent category. CHD comprised 989,380 (79.7%), PAD alone 70,404 (5.7%), ICVD alone 163,730 (13.2%), and PAD + ICVD 18,501 (1.5%) of the cohort. Overall, only 36% received OMT with adjusted odds ratios of 0.54 (95% CI 0.53 to 0.55), 0.77 (0.76 to 0.78), and 0.97 (0.94 to 1.00) for patients with PAD alone, ICVD alone, and PAD + ICVD, respectively, compared with patients with CHD. In conclusion, OMT was low in all groups. Patients with PAD alone and ICVD alone were less likely to receive OMT than those with CHD and PAD + ICVD.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington. Electronic address: hira@uw.edu.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Cowart
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, Texas.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Akeroyd
authors.affiliation: Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ramsey
authors.affiliation: Section of Cardiovascular Research, Department of Medicine, Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Missouri.
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Vijay
authors.initials: V
authors.lastname: Nambi
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Denktas
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Addison
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Cardiovascular Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Health Policy, Quality and Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.affiliation: Division of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Health Policy, Quality and Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001794:Blood Pressure; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000453:epidemiology; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014481:United States; D014728:Veterans
chemical_list: D000925:Anticoagulants; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; C517652:hemoglobin A1c protein, human