Missed Opportunities: Despite Improvement in Use of Cardioprotective Medications among Patients with Lower Extremity Peripheral Artery Disease, Underutilization Remains
Background—Patients with peripheral artery disease (PAD) are at high risk of cardiovascular events and benefit from aggressive secondary prevention; however, changes in use of cardioprotective medications after incident diagnosis of PAD have not been well-described.
Methods and Results—We used Danish nationwide administrative registries (2000-2007) to identify 2 groups with incident PAD: PAD alone (n=34,160) and PAD with history of coronary artery disease (CAD) (n=9570). Using a comparator with incident CAD alone (n=154,183), we assessed temporal trends and comparative use of cardioprotective medications. Relative differences in medication use were examined using multivariable logistic regression. Use of medications improved temporally among both groups: for PAD alone, any antiplatelet use increased from 29% to 59% from 2000 to 2007 (p<0.0001), while statin use increased 6-fold (9% to 56%, p<0.0001). However, use of these therapies by 18 months after incident diagnosis for both PAD groups remained modest and lower compared with CAD alone (any antiplatelet, 53% vs 66%; statins, 40% vs 52%; ACE inhibitors, 20% vs 29%). Relative to CAD alone, patients with PAD alone were less likely to use any antiplatelet (adjusted OR, 0.50; 95% CI, 0.49-0.52), statins (adjusted OR, 0.50; 95% CI, 0.48-0.52]), or angiotensin-converting enzyme (ACE) inhibitors (adjusted OR, 0.51; 95% CI, 0.49-0.53) by 18 months.
Conclusions—Despite improvement in use of cardioprotective medications over time, patients with PAD alone remain less likely than those with CAD alone to use these agents.
- Received April 23, 2012.
- Accepted July 6, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited