on January 25, 2007
Published online before print January 25, 2007, doi: 10.1161/01.STR.0000257310.08310.0f
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Submitted on May 3, 2006
From the Departments of Neurology (E.M.C., S.D.V., E.L.J., B.G.V.) and Medicine (S.M.A.) and the Division of Cardiology (D.S.C.), VA Greater Los Angeles Healthcare System, Los Angeles, Calif; VA Center for the Study of Healthcare Provider Behavior (S.M.A., M.L.L.), Sepulveda, Calif; the Departments of Neurology (E.M.C., S.D.V., B.G.V.) and Medicine (S.M.A., R.H.B.), the Division of Cardiology (D.S.C.), and the School of Public Health (R.H.B., M.L.L.), University of California, Los Angeles, Calif; the RAND Health Program (S.M.A., R.H.B., B.G.V.), Santa Monica, Calif; The Center for Health Policy Research, University of California, Irvine (A.-F.H.), Irvine, Calif; the Medical Healthcare Group, VA Long Beach Healthcare System (A.-F.H.), Long Beach, Calif; and the Departments of Epidemiology and Neurology (R.L.S.), Columbia University, New York, NY. * To whom correspondence should be addressed. E-mail: eric.cheng{at}va.gov.
Background and Purpose--Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein. Methods--Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (n=252), coronary artery bypass graft (n=486), or percutaneous coronary intervention (n=720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using Results--The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure (P=0.05) compared with increases from 32% to 43% for coronary artery bypass graft (P=0.001) and from 29% to 45% for percutaneous coronary intervention (P=0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure (OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein (OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure (OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control. Conclusions--Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients.
Revised on September 18, 2006
Accepted on October 3, 2006
Suboptimal Control of Atherosclerotic Disease Risk Factors After Cardiac and Cerebrovascular Procedures
Eric M. Cheng MD, MS*;
2 tests and multivariate logistic regression.
Key words: cardiac procedures • carotid prevention • secondary prevention