Let's be CLEAR: Cath Lab Evaluation of Atherosclerotic Risk is a disease modifying opportunity

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with early identification and management of risk factors being crucial to its management. Patients undergoing day-case angiograms represent a relatively high-risk population, yet often lack comprehensive risk-factor evaluation. Interventions have been shown to be more consistently aligned with guideline-recommended targets when conducted in hospital. As such, the cardiac catheterisation lab offers an invaluable opportunity for cardiovascular risk factor screening and intervention. We enrolled 585 consecutive patients attending our institution for day-case coronary angiograms. Blood samples were collected for lipid profile and glycated haemoglobin (HbA1c), in addition to blood pressure recordings and a smoking history taken. The results were available for clinician review on the day, with encouragement to intervene on off-target risk factors. We identified high levels of patients with established CAD and risk factors outside of the target range. This included 77% and 70% with low-density lipoprotein (LDL) and non-high-density lipoprotein (non-HDL) above target, respectively. There were also 19% smoking and 14% with HbA1c above target. A number of patients with CAD and previously undiagnosed risk factors were also identified, including 18 newly diagnosed with diabetes. A considerable proportion of these had interventions made on the day of their procedure. Our results demonstrate a clear benefit to risk-factor screening in the catheterisation lab, with a high number of patients found to have risk factors outside of the target range, or previously undiagnosed, and appropriate interventions were made as a result.