Montminy Myriam L, Gauvin Valerie, Turcotte Stephane, Milot Alain, Douville Yvan, Bairati Isabelle
Department of Vascular Surgery, Centre Hospitalier Universitaire de Québec, Quebec, Canada.
Research Center of the Centre Hospitalier Universitaire de Québec, Quebec, Canada.
PLoS One. 2016 Feb 5;11(2):e0148069. doi: 10.1371/journal.pone.0148069. eCollection 2016.
Guidelines recommend that patients with peripheral arterial disease should be medically treated to reduce the occurrence of serious cardiovascular events. Despite these recommendations, studies conducted in the early 2000s reported that medical therapies for secondary cardiovascular prevention are not given systematically to patients with peripheral arterial disease (PAD). We identified factors associated with the prescription of preventive therapies in patients with symptomatic PAD.
Consecutive patients with symptomatic peripheral arterial disease (n = 362) treated between 2008 and 2010 in one tertiary care center (CHU de Quebec, Canada) were considered. Data were collected from the medical charts. The main outcome was the combined prescription of three therapies: 1) statins, 2) antiplatelets, 3) angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. The mean age was 70 years and 43% had a pre-existing coronary artery disease. Antiplatelet therapy was the most prescribed drug (83%). A total of 52% of the patients received the three combined therapies. Less than 10% of patients had a known contraindication to one class of medication. Having at least three cardiovascular risk factors (Odds Ratio (OR) = 4.51; 95% CI: 2.76-7.37) was the factor most strongly associated with the prescription of the combined therapies. Pre-existing coronary artery disease (OR = 2.28; 95% CI: 1.43-3.65) and history of peripheral vascular surgery (OR = 2.30; 95% CI: 1.37-3.86) were two factors independently associated with the prescription of the combined therapies. However, peripheral arterial disease patients with chronic critical limb ischemia were less likely to receive the combined therapies (OR = 0.53; 95% CI: 0.32-0.87) than those with claudication. The retrospective nature of this study, not allowing for an exhaustive report of the contraindication to medication prescription, is the main limitation.
About half of the patients with peripheral arterial disease were not optimally managed. Patients with multiple cardiovascular risk factors were more likely to receive the combined therapies. We still need to better understand the barriers and facilitators to the application of the guidelines.
指南建议，外周动脉疾病患者应接受药物治疗以降低严重心血管事件的发生率。尽管有这些建议，但21世纪初开展的研究报告称，外周动脉疾病（PAD）患者并未系统地接受二级心血管预防的药物治疗。我们确定了有症状的PAD患者中与预防性治疗处方相关的因素。
纳入2008年至2010年在加拿大魁北克大学中心医院这一三级医疗中心接受治疗的连续的有症状外周动脉疾病患者（n = 362）。从病历中收集数据。主要结局是三种治疗的联合处方：1）他汀类药物，2）抗血小板药物，3）血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。平均年龄为70岁，43%的患者既往有冠状动脉疾病。抗血小板治疗是处方最多的药物（83%）。共有52%的患者接受了三种联合治疗。不到10%的患者已知对某一类药物有禁忌证。具有至少三种心血管危险因素（比值比（OR）= 4.51；95%置信区间：2.76 - 7.37）是与联合治疗处方最密切相关的因素。既往有冠状动脉疾病（OR = 2.28；95%置信区间：1.43 - 3.65）和外周血管手术史（OR = 2.30；95%置信区间：1.37 - 3.86）是与联合治疗处方独立相关的两个因素。然而，与间歇性跛行患者相比，慢性严重肢体缺血的外周动脉疾病患者接受联合治疗的可能性较小（OR = 0.53；95%置信区间：0.32 - 0.87）。本研究的回顾性性质，不允许详尽报告药物处方的禁忌证，是主要局限性。
约一半的外周动脉疾病患者未得到最佳管理。具有多种心血管危险因素的患者更有可能接受联合治疗。我们仍需要更好地了解指南应用的障碍和促进因素。
