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Published on: June 3, 2018
Changes in preventive medical therapies and CV risk factors after CT angiography
Michael K Cheezum1, Edward A Hulten, Ryan M Smith
1Cardiology Service, Walter Reed National Military Medical Center, Bethesda, Maryland 20889-5600, USA.
Insights
Coronary artery disease (CAD) identified by coronary computed tomographic angiography (CTA) is linked to increased use of preventive medications like aspirin and statins, and improved cholesterol and blood pressure levels.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- The impact of coronary computed tomographic angiography (CTA) findings on prescribing preventive cardiovascular medications and modifying risk factors remains unclear.
- Understanding this relationship is crucial for optimizing patient care and treatment strategies.
Purpose of the Study:
- To investigate the association between coronary artery disease (CAD) detected by CTA and the subsequent use of aspirin, statins, and antihypertensive medications.
- To evaluate the impact of CTA-identified CAD on cholesterol levels and blood pressure (BP) post-diagnosis.
Main Methods:
- A study involving 1,125 patients without known CAD who underwent coronary CTA.
- CAD was categorized as none, nonobstructive (<50%), or obstructive (≥50%).
- Medication use (aspirin, statins, BP treatments) and lipid/BP values were compared pre- and post-CTA.
Main Results:
- Patients with nonobstructive and obstructive CAD showed significant increases in the use of statins, BP medications, and aspirin compared to those without CAD.
- Significant improvements were observed in total cholesterol, LDL cholesterol, systolic BP, and diastolic BP in patients with CAD.
- CTA-identified CAD independently predicted increased use of aspirin, statins, and BP medications.
Conclusions:
- The presence and severity of CAD identified by CTA are associated with enhanced utilization of preventive cardiovascular medications.
- CTA findings correlate with positive changes in lipid profiles and blood pressure control, underscoring its clinical utility.
Objectives:
The aim of the study was to determine the association of coronary computed tomographic angiography (CTA)-identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and changes in cholesterol and blood pressure (BP).
Background:
The relationship of CTA findings to subsequent changes in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown.
Methods:
We studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (<50%), or obstructive (≥50%). Prescriptions were queried in the 6 months pre- and post-CTA for comparison of aspirin, statin, and BP treatment. Medication intensification was defined as initiation, dose increase, or, for statins, change to a more potent formulation. Lipid and BP values were obtained at 12 months pre- and post-CTA.
Results:
Patients were 50 ± 12 years of age (59% men), with 34%, 47%, and 33% on baseline statin, BP medication(s), and aspirin, respectively. Relative to patients without CAD (n = 617), patients with nonobstructive (n = 411) and obstructive CAD (n = 97) demonstrated significant intensification in unadjusted rates of statin (26%, 46%, and 46% of patients; p < 0.001), BP (11%, 21%, and 24%; p < 0.001), and aspirin therapies (9%, 29%, and 40%; p < 0.001), and significant improvements in total cholesterol (-6.7, -14.7, and -24.7 mg/dl; p = 0.008), low-density lipoprotein cholesterol (-5.6, -14.1, and -24.6 mg/dl; p = 0.001), systolic (+0.1, -1.4, and -4.9 mm Hg; p = 0.002), and diastolic BP (-0.6, -1.0, and -3.4 mm Hg; p = 0.012), respectively. Adjusted for baseline risk factors and medications, CAD was independently associated with increased aspirin, statin, and BP medication use rates in CTA-identified nonobstructive CAD (odds ratio [OR]: 6.9, 95% confidence interval [CI]: 4.7 to 10.2; OR: 6.6, 95% CI: 3.0 to 14.3; OR: 1.6, 95% CI: 1.1 to 2.2, respectively; p < 0.05), and aspirin and statin use in obstructive CAD (OR: 42.4, 95% CI: 15.8 to 113.9; OR: 30.3, 95% CI: 3.2 to 289.2, respectively; p < 0.05).
Conclusions:
CAD presence and severity on CTA are associated with increased use of preventive cardiovascular medications and improvements in cholesterol and BP.
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