BACKGROUND AND PURPOSE: Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein. METHODS: Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (n=252), coronary artery bypass graft (n=486), or percutaneous coronary intervention (n=720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using chi(2) tests and multivariate logistic regression. RESULTS: The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure (P=0.05) compared with increases from 32% to 43% for coronary artery bypass graft (P=0.001) and from 29% to 45% for percutaneous coronary intervention (P=0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure (OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein (OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure (OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control. CONCLUSIONS: Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients.
BACKGROUND AND PURPOSE: Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein. METHODS: Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (n=252), coronary artery bypass graft (n=486), or percutaneous coronary intervention (n=720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using chi(2) tests and multivariate logistic regression. RESULTS: The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure (P=0.05) compared with increases from 32% to 43% for coronary artery bypass graft (P=0.001) and from 29% to 45% for percutaneous coronary intervention (P=0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure (OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein (OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure (OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control. CONCLUSIONS: Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients.
Authors: Eric M Cheng; William E Cunningham; Amytis Towfighi; Nerses Sanossian; Robert J Bryg; Thomas L Anderson; Jeffrey J Guterman; Sandra G Gross-Schulman; Sylvia Beanes; Andrea S Jones; Honghu Liu; Susan L Ettner; Jeffrey L Saver; Barbara G Vickrey Journal: Circ Cardiovasc Qual Outcomes Date: 2011-03
Authors: George A Mensah; Ralph L Sacco; Barbara G Vickrey; Uchechukwu K A Sampson; Salina Waddy; Bruce Ovbiagele; Jeyaraj Durai Pandian; Bo Norrving; Valery L Feigin Journal: Neuroepidemiology Date: 2015-10-28 Impact factor: 3.282
Authors: Amytis Towfighi; Eric M Cheng; Monica Ayala-Rivera; Frances Barry; Heather McCreath; David A Ganz; Martin L Lee; Nerses Sanossian; Bijal Mehta; Tara Dutta; Ali Razmara; Robert Bryg; Shlee S Song; Phyllis Willis; Shinyi Wu; Magaly Ramirez; Adam Richards; Nicholas Jackson; Jeremy Wacksman; Brian Mittman; Jamie Tran; Renee R Johnson; Chris Ediss; Theresa Sivers-Teixeira; Betty Shaby; Ana L Montoya; Marilyn Corrales; Elizabeth Mojarro-Huang; Marissa Castro; Patricia Gomez; Cynthia Muñoz; Diamond Garcia; Lilian Moreno; Maura Fernandez; Enrique Lopez; Sarah Valdez; Hilary R Haber; Valerie A Hill; Neal M Rao; Beatrice Martinez; Lillie Hudson; Natalie P Valle; Barbara G Vickrey Journal: JAMA Netw Open Date: 2021-02-01