Abstract P184: Reduction in Atherosclerotic Events Through Use of Aggressive Risk Factor Reduction Medications in an Outpatient Cardiology Practice

Abstract

Background : Although atherosclerotic disease cannot be cured, risk of recurrent events can be reduced by application of evidence based treatment protocols involving aspirin, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statin medications. Purpose : To compare atherosclerosis event rates in a patient population treated before and after the development of aggressive risk factor reduction treatment protocols. Methods : A retrospective chart review study of patients presenting for follow-up treatment of coronary artery disease in a community cardiology practice, comparing event rates and medication usage in a 2 year treatment period prior to 2002 to a 2 year treatment period in 2005-2008. Standard care was provided in both the early treatment era and the later era by board-certified cardiologists in a 7 physician suburban cardiology practice. Medication usage was compared in both treatment eras. The primary outcome was a composite event rate of myocardial infarction, cerebrovascular events (transient ischemic attacks or cerebrovascular accident), and coronary interventions (percutaneous or surgical). The outcome measures were identified before data collection or analysis were performed. Results : 357 patients were studied for 2 year periods in each era, with a total follow-up duration of 12.1 (± 3.5) years. There were 132 composite events in 104 patients (29.1%) in the early era compared to 40 events in 33 patients (9.2%) in the later era (p< 0.0001). This result was driven mostly by a reduction in percutaneous and surgical coronary interventions between the 2 eras. From the early to the late eras, there was an increase in the use of beta blockers (66% to 83%, p<0.0001), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (34% to 80%, p<0.0001), and statins (40% to 90%, p<0.0001); although aspirin usage did not increase, it was prescribed frequently in both eras (78% and 79%). Conclusions : Application of aggressive evidence-based medication protocols for treatment of atherosclerosis is associated with a significant decrease in events or need for coronary intervention.