[Drug prescription in the post-percutaneous coronary interventions period: results of the ECART study]

Percutaneous coronary interventions for coronary artery disease: the long and short of optimizing medical therapy

Atherosclerosis is a dynamic process and timely introduction of pharmacological treatment can have a significant bearing on the patient's health and outcome. In addition to treating the culprit lesion mechanically, admission for percutaneous coronary interventions (PCI) for coronary artery disease (CAD) gives an opportunity for the interventional cardiologist to optimize medical therapy. The aim of this review is to provide an overview of the current medical literature pertaining to cardiovascular (CV) risk reduction and vascular event prevention in the setting of PCI, with emphasis on antiplatelet therapies, beta-blockers, HMG-Co A reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors, with regard to therapy optimization during PCI and for chronic CAD. We discuss the effects of these oral therapies in reducing ischaemic events, thus augmenting the benefits of PCI, as well as preventing recurrent CV events after the procedure.

[Utilization of the principle therapeutic classes for cardiovascular prevention in elderly patients seen by cardiologists. The ELIAGE survey]

Limited data are available regarding drug prescription for cardiovascular prevention in elderly patients seen by cardiologists.

METHODS

The ELIAGE survey was conducted in France between March and September 2003 among 507 cardiologists. 1952 consecutives elderly patients (> or = 70 years old) were enrolled. Mean age was 76 years, 40% were between 70 and 74, and 26% were more than 80. Sixty-two of patients were men. Sixteen percent of patients had no history of cardiovascular disease but presented at least one of major cardiovascular risk factor: hypertension (91%), hyperlipemia (58%), diabetes (28%), and/or smoking (6%). Eighty-four percent had a known history of occlusive, atherosclerotic vascular disease: coronary heart disease in 76%, peripheral artery disease in 17%, and prior stroke or transient ischemic attack in 13%. Heart failure was observed in 21%.

RESULTS

The rates of prescription in the overall survey population were respectively 68% for antiplatelet agents, 67% for lipid lowering drugs (of which 85% were on a statin), 51% for beta-blockers and 41% for angiotensin converting enzyme inhibitors. Among patients with coronary heart disease, prescription rates were 42% for ACE-inhibitors, 58% for beta-blockers, 76% for antiplatelet agents and 72% for lipid-lowering agents, 85% of whom received a statin. The ELIAGE survey shows a high prevalence of persistent dyslipidemia, with 46% of patients having a LDL-cholesterol equal to or greater than 1.25 g/l and 15% > or = 1.60 g/l. Despite lipid-lowering therapy, LDL-cholesterol remained equal to or greater than 1.25 g/l in 40% of treated patients and > or = 1.60 g/l in 13%. Blood pressure control was not better with 61% of patients having systolic blood pressure > or = 140 mmHg and 21% > or = 160 mmHg. In multivariate analysis, increase was inversely associated with the prescription of lipid-lowering therapy.

CONCLUSION

The ELIAGE survey in France shows the persistence of poor control of modifiable risk factors among elderly patients seen by cardiologists. Both primary and secondary cardiovascular prevention appear to be unsatisfactory. Improved utilisation of proven therapeutic classes may lead to improvements in cardiovascular prevention.