Abstract P65: Risk Factor Reduction in the Progression of Coronary Artery Disease in an Outpatient Cardiology Practice

Abstract

Background : Treating patients who received multiple cardiac catheterizations can be difficult because they are more likely to have multiple risk factors for coronary artery disease (CAD), complex coronary anatomy, and recurrent angina requiring repeated cardiac evaluation. Purpose : The aim of this study was to evaluate patients with at least two coronary angiograms and identify differences between the patients with progressive CAD (PCAD) and no progressive CAD (NPCAD) in an outpatient cardiology practice. Methods : Chart reviews were performed in patients receiving two or more cardiac catheterizations at least one year apart. The study population was divided into patients with PCAD and NPCAD. Progression of CAD was defined as 1: new non-obstructive or obstructive disease in a previously disease-free vessel; or 2: new obstruction in a previously non-obstructive vessel. Medication use, serum low-density lipoprotein cholesterol (LDL-C) and blood pressure were used for analysis. Results : The study included 183 patients, with 131 males and 52 females, mean age 71 ± 10 years. The average follow-up duration was 11 years. Of 183 patients, PCAD had 108 patients (59%), and NPCAD had 75 patients (41%). Statins were used in 80 patients (74%) with PCAD and in 55 patients (73%) with NPCAD (p not significant (NS)). Beta blockers were used in 85 patients (79%) with PCAD and in 61 patients (81%) with NPCAD (p NS). Angiotensin-converting enzyme inhibitors were used in 49 patients (45%) with PCAD and in 32 patients (43%) with NPCAD (p NS). Aspirin was used in 86 patients (80%) with PCAD and in 60 patients (80%) with NPCAD (p NS). Mean arterial pressure was higher in PCAD than in NPCAD (97 ± 13 mm Hg versus 92 ± 12 mm Hg) (p<0.05). Serum LDL-C level was insignificantly higher in PCAD (94 ± 41 mg/dL) than in NPCAD (81 ± 34 mg/dL) (p=0.09). Conclusion : There was no difference in medical therapy of patients with and without PCAD. However, patients with PCAD had a higher blood pressure and a trend toward higher serum LDL-C level. Our data suggest that in addition to using appropriate medical therapy, aggressive control of blood pressure and serum LDL-C level may reduce progression of CAD.