Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome
Andrés Gaviria-Mendoza1,2,3, Julián Andrés Zapata-Carmona1, Andrés Alirio Restrepo-Bastidas1
1Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia.
Insights
Many high-risk cardiovascular patients did not receive necessary primary prevention medications like statins and aspirin, despite guidelines. This gap in treatment highlights a critical issue in preventing acute coronary events.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Cardiovascular disease, particularly coronary disease, is a leading cause of illness and death globally.
- Effective primary prevention strategies are crucial for mitigating the impact of cardiovascular events.
Purpose of the Study:
- To analyze the drug prescription patterns for primary cardiovascular prevention in patients before their first acute coronary syndrome (ACS).
- To identify gaps in the use of preventive medications based on established clinical guidelines.
Main Methods:
- A cross-sectional study involving 322 adult patients in Colombia diagnosed with a first ACS between 2015-2016.
- Evaluation of sociodemographic, clinical, and pharmacological data from medical records.
- Calculation of pre-event cardiovascular risk scores (Framingham and AHA) and assessment of guideline-based need for statins and aspirin.
Main Results:
- The study included patients with high prevalence of dyslipidemia (64.3%), hypertension (62.7%), and diabetes (30.1%).
- A significant proportion of patients needing statins (31.3%) and aspirin (43.2%) for primary prevention did not receive them.
- Among those needing high-intensity statins, 72.6% did not receive the indicated treatment.
Conclusions:
- Real-world data reveal a substantial underuse of essential primary preventive medications in high-risk cardiovascular patients.
- This gap in guideline-adherent prescribing may contribute to preventable acute coronary events.
Abstract:
Background: Cardiovascular disease, especially coronary disease, represents one of the main causes of morbidity and mortality. Objective: To determine the drug prescription profile for primary cardiovascular prevention prior to a first acute coronary syndrome event. Methods: Cross-sectional study. We included adult patients of any sex affiliated with one healthcare insurer of the Colombian Health System, with a diagnosis of a first episode of acute coronary syndrome that occurred during the period of 2015 to 2016. Sociodemographic, clinical and pharmacological variables were evaluated from clinical records. The cardiovascular risk score prior to the event was calculated, and the need for the use of statins and aspirin in primary prevention was defined according to the recommendations of clinical practice guidelines. Results: Clinical records of 322 patients were reviewed with mean age of 61.9 ± 10.8 years, and 77.3% were men. The most frequent comorbidities were dyslipidemia (64.3%), arterial hypertension (62.7%) and diabetes mellitus (30.1%); 22% of the patients were obese, and 33.5% were smokers. The cardiovascular risk score was calculated in 211 patients (65.5%) who had the necessary variables complete. The median 10-year risk according to Framingham risk score was 21.4%, and it was 16.3% according to the American Heart Association. From the 211 patients with risk scores, there were 179 (84.8%) who needed statins (175 of high intensity, 97.8%), and 88 (27.3%) required aspirin as a primary prevention; however, 56 of these patients (31.3%) did not receive any statins, 127 (72.6%) did not receive the high intensity statin they needed, and 38 (43.2% of those with indication) lacked aspirin. Conclusion: Real-life data show that among a group of patients with high cardiovascular risk, a substantial proportion were not receiving medications for primary prevention necessary to reduce their risk and finally suffered an acute coronary event.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Angina IV: Management
01:26Atherosclerosis III: Management
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...