Changes in Preventive Medical Therapies and CV Risk Factors After CT Angiography

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• 作者：Michael K. Cheezum ; MD^? ; Edward A. Hulten ; MD ; MPH^&dagger ; ; Ryan M. Smith ; DO^? ; Allen J. Taylor ; MD^&Dagger ; ; Jacqueline Kircher ; MD^§ ; ; Luke Surry ; MD^¡Î ; Matthew York^¶ ; ; Todd C. Villines ; MD^? ; ^{todd.c.villines@health.mil}
• 关键词：aspirin ; coronary artery disease ; coronary CT angiography ; dyslipidemia ; hypertension
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：6
• 期：5
• 页码：574-581
• 全文大小：417 K

文摘

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Objectives

The aim of the study was to determine the association of coronary computed tomographic angiography (CTA)-identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and changes in cholesterol and blood pressure (BP).

Background

The relationship of CTA findings to subsequent changes in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown.

Methods

We studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (<50 % ), or obstructive (¡Ý50 % ). Prescriptions were queried in the 6 months pre- and post-CTA for comparison of aspirin, statin, and BP treatment. Medication intensification was defined as initiation, dose increase, or, for statins, change to a more potent formulation. Lipid and BP values were obtained at 12 months pre- and post-CTA.

Results

Patients were 50 ¡À 12 years of age (59 % men), with 34 % , 47 % , and 33 % on baseline statin, BP medication(s), and aspirin, respectively. Relative to patients without CAD (n = 617), patients with nonobstructive (n = 411) and obstructive CAD (n = 97) demonstrated significant intensification in unadjusted rates of statin (26 % , 46 % , and 46 % of patients; p < 0.001), BP (11 % , 21 % , and 24 % ; p < 0.001), and aspirin therapies (9 % , 29 % , and 40 % ; p < 0.001), and significant improvements in total cholesterol (?6.7, ?14.7, and ?24.7 mg/dl; p = 0.008), low-density lipoprotein cholesterol (?5.6, ?14.1, and ?24.6 mg/dl; p = 0.001), systolic (+0.1, ?1.4, and ?4.9 mm Hg; p = 0.002), and diastolic BP (?0.6, ?1.0, and ?3.4 mm Hg; p = 0.012), respectively. Adjusted for baseline risk factors and medications, CAD was independently associated with increased aspirin, statin, and BP medication use rates in CTA-identified nonobstructive CAD (odds ratio [OR]: 6.9, 95 % confidence interval [CI]: 4.7 to 10.2; OR: 6.6, 95 % CI: 3.0 to 14.3; OR: 1.6, 95 % CI: 1.1 to 2.2, respectively; p < 0.05), and aspirin and statin use in obstructive CAD (OR: 42.4, 95 % CI: 15.8 to 113.9; OR: 30.3, 95 % CI: 3.2 to 289.2, respectively; p < 0.05).

Conclusions

CAD presence and severity on CTA are associated with increased use of preventive cardiovascular medications and improvements in cholesterol and BP.