PCV169 ACETYLSALICYLIC ACID(ASA) MONOTHERAPY FOR SECONDARY PREVENTION OF CARDIOVASCULAR EVENTS IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE: AN ASSESSMENT OF THE MEDICAL BENEFIT USING THE IQWIG METHODOLOGICAL APPROACH

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

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Comparison between four equations for the estimation of glomerular filtration rate in predicting future cardiovascular events and the existing peripheral arterial disease

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.270 ◽

2021 ◽

Vol 13 (1) ◽

pp. 129

Author(s):

M. Sow ◽

J. Magne ◽

A. Kenne Malaha ◽

K. Mansour ◽

M. Ait--Ouatet ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Peripheral Arterial Disease ◽

Glomerular Filtration ◽

Cardiovascular Events ◽

Filtration Rate ◽

Arterial Disease ◽

Peripheral Arterial

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Attainment of low-density lipoprotein cholesterol goal after endovascular treatment is associated with reduced cardiovascular events in patients with peripheral arterial disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.09.059 ◽

2016 ◽

Vol 63 (3) ◽

pp. 756-763 ◽

Cited By ~ 6

Author(s):

Jung-Hee Lee ◽

Young-Guk Ko ◽

Dong-Ho Shin ◽

Jung-Sun Kim ◽

Byeong-Keuk Kim ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Endovascular Treatment ◽

Cardiovascular Events ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Arterial Disease ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Cholesterol Goal ◽

Peripheral Arterial

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Abstract 278: Lipid Control in Patients With New Symptoms of Peripheral Arterial Disease Evaluated at Vascular Specialty Clinics

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a278 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Kim Smolderen ◽

Jan-Willem Elshof ◽

Moniek van Zitteren ◽

John A Spertus ◽

Johan Denollet ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Arterial Disease ◽

Secondary Prevention ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Initial Evaluation ◽

Specialty Clinic ◽

Lipid Control ◽

Peripheral Arterial

Background: Obtaining adequate lipid control (LDL-Cholesterol [LDL] <100 mg/dL) in patients with peripheral arterial disease (PAD) is a critical, guideline-directed secondary prevention target. Current compliance with this recommendation is unknown. Methods: A total of 616 patients had their LDL levels measured at 2 vascular specialty clinics in the Netherlands (March 2006-November 2011) during the evaluation of new PAD symptoms. A year following this evaluation, 417 (68%) patients had their LDL levels re-assessed. Information about patients’ demographic and clinical factors was systematically abstracted from medical records. Categories of patients were created based on the attainment of the recommended LDL target (<100 mg/dL [on target] vs. ≥100 mg/dL [off target]). Predictors of being off target at initial evaluation and at 1-year follow-up were identified through multivariable logistic regression analyses. Results: Of the total group, 57% (351/616) were off target at initial evaluation and 81% (496/616) were on lipid-lowering drugs after the initial evaluation at the PAD specialty clinic. One year later, only 25% (103/417) got on target, while 35% (147/417) patients remained off target, and an additional 10% (43/417) saw an increase in LDL to become off target. A total of 30% (124/417) remained on target. Patients with hypertension, diabetes, a history of myocardial infarction, and a lower ankle-brachial index were less likely to be off target at initial evaluation. Predictors of being off target at 1-year follow-up were male sex, and having a higher ankle-brachial index ( Table ). Conclusion: About half of patients with PAD seen at vascular specialty clinics had above-target LDL levels both upon entry and 1 year later. Patients with existing cardiovascular risk factors were much better controlled, as compared with patients without such risk factors. Males and those with higher ankle-brachial indices were less likely to be on target 1 year following management at the specialty clinic. Reasons for poorly regulated lipids need to be further explored, and appropriate quality-of-care improvement strategies will likely be needed to optimize secondary prevention.

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Abstract 20579: Chronic Kidney Disease is Associated With Increased Mortality and Major Adverse Cardiovascular Events in Patients With Peripheral Arterial Disease

Circulation ◽

10.1161/circ.130.suppl_2.20579 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Gregory G Westin ◽

Ehrin J Armstrong ◽

Debbie C Chen ◽

John R Laird

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Cardiovascular Events ◽

Cox Model ◽

Univariate Analysis ◽

Arterial Disease ◽

Major Adverse Cardiovascular Events ◽

Ckd Stage ◽

Peripheral Arterial

Introduction: Chronic kidney disease (CKD) is common in patients with peripheral arterial disease (PAD), but patients with severe CKD have been excluded from many trials and no objective performance goals exist for patients with PAD and CKD. We sought to analyze the association between severity of CKD and cardiovascular and limb-related outcomes among patients with PAD. Methods: We reviewed records of all patients at our institution who underwent lower extremity angiography between 2006 and 2013. We analyzed outcomes including mortality, major adverse cardiovascular event (MACE) rate, and major adverse limb event (MALE) rate according to clinical stage of CKD, determined by calculating each patient’s glomerular filtration rate using the Cockcroft-Gault equation. We used Cox proportional hazard modeling to account for covariates, along with Bonferroni correction for multiple comparisons. Results: Of 773 patients, 45% had CKD stage 3-5. The patients had a median age of 67, were 58% male, 51% diabetic, and 57% presented with critical limb ischemia (CLI). During a median follow-up time of 3.2 years, patients with higher stages of CKD had an increased rate of death (Figure 1, p<0.001). CKD stages 4 and 5 were significant predictors of mortality in a multivariate model (HR 3.2 and 2.4 vs. CKD 1, P<0.001 and P<0.01, respectively). An analysis of MACE by CKD stage demonstrated similar results (CKD 4 HR 2.2, p<0.01; CKD 5 HR 2.0, p<0.01). CKD stage also predicted MALE in a univariate analysis (p<0.01), driven by increased limb events among patients with CKD stage 5 (p<0.01). However, CKD stage did not demonstrate a significantly increased hazard of MALE in a multivariate Cox model. Conclusions: Patients with PAD who also have CKD have increased rates of adverse outcomes. This relationship seems to be more robust for major cardiovascular events and overall mortality than for major limb events. Future studies should investigate how management of PAD should differ for patients with CKD.

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