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[Profile of risk factors modification after coronary revascularization in patients with coronary artery disease]
Shao-ping Nie1, Xiao-hui Liu, Xin Du
1Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Insights
Risk factor modification after coronary revascularization is suboptimal, with many patients continuing to smoke and poorly managing weight, blood sugar, blood pressure, and lipids. Enhanced secondary prevention and patient education are crucial.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Context:
- Coronary artery disease (CAD) management requires addressing modifiable risk factors post-revascularization.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are common revascularization procedures.
- Evidence-based guidelines exist for risk factor management in CAD patients.
Purpose:
- To assess risk factor modification in patients after PCI or CABG.
- To identify the gap between real-world practice and evidence-based guidelines for CAD secondary prevention.
- To evaluate changes in smoking status, body weight, blood pressure, fasting blood sugar, and lipid levels post-revascularization.
Summary:
- A registry study of 3767 patients followed for a median of 670 days found suboptimal risk factor control post-revascularization.
- Continued smoking, weight gain, elevated blood sugar and lipids, and uncontrolled hypertension were prevalent.
- Specifically, 18.5% of smokers continued, 24.3% of overweight/obese patients gained weight, and significant proportions had worsened glycemic, pressure, and lipid control.
Impact:
- Findings highlight a significant gap between clinical practice and evidence-based guidelines for secondary prevention in CAD.
- There is a critical need for enhanced secondary prevention strategies and patient education.
- Interventions are required to improve long-term outcomes and reduce cardiovascular events in patients undergoing revascularization.
Objective:
To elucidate the profile of risk factors modification after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with coronary artery disease in order to scale the gap between real world practice and evidence-based guidelines.
Methods:
3767 patients with at least 30 days' followed-up after discharge in the single-center DESIRE (Drug-Eluting Stent Impact on REvascularization) registry were enrolled to compare in-hospital and follow-up data including smoking, body weight, blood pressure, fasting blood sugar and lipid levels.
Results:
Of the 3763 patients, 3017 (80.2%) were successfully followed up for at least one month with a median of 670 (35 - 1930) days. During follow-up, 18.5% (170/917) of the in-hospital current smokers continued smoking, whereas 6.1% (71/1168) of the non-current smokers during hospitalization became cigarette addict despite a marked reduction in the general rate of current smoking (43.5% vs 9.5%, P < 0.0001). At follow-up, 24.3% (264/1087) of the overweight or obese patients experienced weight gain after revascularization. In patients with diabetes mellitus, 48.3% (143/296) had higher follow-up levels of average fasting blood sugar. In patients complicated with hypertension, 33.1% (469/1419) and 31.9% (453/1419) had higher average systolic or diastolic pressures than in-hospital measurements. During follow-up, 36.4% (111/184) had lower levels of serum high-density lipoprotein cholesterol (HDL-C), whereas 54.1% (98/181) and 56.8% (121/213) patients had higher levels of serum low-density lipoprotein cholesterol (LDL-C) and triglycerlin (TG).
Conclusion:
Risk factors modification after coronary revascularization is far beyond optimal, with a high rate of continued smoking and poor control of body weight, blood sugar, blood pressure and serum lipids. Prompt and effective measures should be taken to enhance the secondary prevention and patient education to minimize the gap between clinical practice and evidence-based guidelines.
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