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Protective Vascular Treatment of Patients with Peripheral Arterial Disease: Guideline Adherence According to Year, Age and Gender

  • Quantitative Research 2009
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Abstract

Objectives

To evaluate vasoprotective pharmacological treatment of patients with peripheral arterial disease (PAD) according to: 1) year, 2) age and 3) gender.

Methods

An observational retrospective study was conducted to evaluate the systemic vascular treatment of a population-based cohort of patients with PAD ≥50 years old, discharged from a tertiary-care teaching hospital between January 1, 1997 and December 11, 2006. Data were obtained from the Régie de l’assurance maladie du Québec. Drugs evaluated included antiplatelet agents (APs), statins (STs) and angiotensin converting enzyme inhibitors (ACEIs), and a combination of all three. Proportions of patients treated were compared according to year, age and gender using Chi-square.

Results

The mean age of the study population (5962 individuals) was 73.2 ± 9.1 years; 43.8% were women. After hospital discharge, 71.6%, 47.6%, 42.2% and 20.6% were taking respectively, an AP, statin, ACEI or all three. Protective treatment improved significantly from 1997 to 2006. Significantly more subjects 50–64 years used a statin or all three agents, compared to subjects ≥65 years (statins: 56.6% vs. 45.8%, all three: 26.2% vs. 19.5%; p<0.001). Significantly more men than women used statins (49.1% vs. 45.6%; p<0.001) and ACEIs (44.5% vs. 39.3%; p<0.001). Similarily, use of all three agents was 22.4% for men and 18.2% for women (p<0.001).

Conclusions

Although systemic vascular treatment received by patients with PAD has increased in the past years, it remains suboptimal, particularly for older patients and women. Strategies to improve adherence to treatment guidelines should be developed for these high-risk populations.

Résumé

Objectifs

Évaluer l’utilisation du traitement pharmacologique vasoprotecteur de patients atteints de la maladie vasculaire artérielle périphérique (MVAP) et plus spécifiquement comparer le traitement selon: 1) l’année, 2) l’âge et 3) le sexe.

Méthode

Nous avons mené une étude observationnelle rétrospective pour évaluer le traitement vasoprotecteur d’une cohorte de patients de ≥50 ans atteints de la MVAP, ayant reçu leur congé d’un hôpital universitaire tertiaire entre le 1er janvier 1997 et le 11 décembre 2006. Les données ont été obtenues de la Régie de l’assurance maladie du Québec. Le traitement pharmacologique évalué incluait l’utilisation d’antiplaquettaires (AP), de statines (ST), d’inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) et des trois à la fois. Les proportions de patients traités étaient comparées selon le temps, l’âge et le sexe à l’aide du test du khi-carré.

Résultats

L’âge moyen de la population (n=5 962) était de 73,2 ± 9,1 ans, dont 43,8% de femmes. Après le congé hospitalier, respectivement 71,6%, 47,6%, 42,2% et 20,6% prenaient un antiplaquettaire, une statine, un IECA ou les trois agents. L’utilisation du traitement vasoprotecteur augmente significativement de 1997 à 2006. Plus de patients jeunes, de 50–64 ans, utilisent une ST ou les trois agents simultanément comparativement aux patients de ≥65 ans (statine: 56,6% comparativement à 45,8%, les trois: 26,2% comparativement à 19,5%; p<0,001). Significativement plus d’hommes que de femmes utilisaient une ST (49,1% contre 45,6%; p<0,001) et un IECA (44,5% contre 39,3%; p<0,001). De façon similaire, 22,4% d’hommes comparativement à 18,2% de femmes utilisaient les trois agents en même temps (p<0,001).

Conclusions

Malgré une amélioration dans les dernières années, l’utilisation du traitement vasoprotecteur des patients atteints de MVAP demeure sous-optimal, particulièrement en ce qui concerne les femmes et les personnes âgées. Des stratégies pour augmenter l’adhésion aux recommandations émises pour le traitement vasoprotecteur de ces personnes à haut risque vasculaire devraient être élaborées.

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References

  1. Expert Panel on Detection EaToHBCiA. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).[see comment]. JAMA 2001;285(19):2486–97.

    Google Scholar 

  2. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001;344(21):1608–21.

    Article  CAS  PubMed  Google Scholar 

  3. Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: Importance of identifying the population at risk. Vascular Med 1997;2(3):221–26.

    Article  CAS  Google Scholar 

  4. Higgins JP, Higgins JA. Epidemiology of peripheral arterial disease in women. J Epidemiol 2003;13(1):1–14.

    Article  PubMed  Google Scholar 

  5. Sigvant B, Wiberg-Hedman K, Bergqvist D, Rolandsson O, Andersson B, Persson E, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vascular Surgery 2007;45(6):1185–91.

    Article  Google Scholar 

  6. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: Results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 2004;110(6):738–43.

    Article  PubMed  Google Scholar 

  7. Zheng ZJ, Rosamond WD, Chambless LE, Nieto FJ, Barnes RW, Hutchinson RG, et al. Lower extremity arterial disease assessed by ankle-brachial index in a middle-aged population of African Americans and whites: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Prev Med 2005;29(5 Suppl 1):42–49.

    Article  PubMed  Google Scholar 

  8. Sritara P, Sritara C, Woodward M, Wangsuphachart S, Barzi F, Hengprasith B, et al. Prevalence and risk factors of peripheral arterial disease in a selected Thai population. Angiology 2007;58(5):572–78.

    Article  CAS  PubMed  Google Scholar 

  9. Hiatt WR, Regensteiner JG, Hargarten ME, Wolfel EE, Brass EP. Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 1990;81(2):602–9.

    Article  CAS  PubMed  Google Scholar 

  10. Smith GD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study.[see comment]. Circulation 1990;82(6):1925–31.

    Article  CAS  PubMed  Google Scholar 

  11. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.[see comment][erratum appears in 2000;342(18):1376]. N Engl J Med 2000;342(3):145–53.

    Article  CAS  PubMed  Google Scholar 

  12. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Concensus (TASC). J Vascular Surgery 2000;31(1 Pt 2):S1–S296.

    CAS  Google Scholar 

  13. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992;326(6):381–86.

    Article  CAS  PubMed  Google Scholar 

  14. Abramson BL, Huckell V, Anand S, Forbes T, Gupta A, Harris K, et al. Canadian Cardiovascular Society Consensus Conference: Peripheral arterial disease - Executive summary. Can J Cardiology 2005;21(12):997–1006.

    Google Scholar 

  15. Anonymous. Collaborative overview of randomised trials of antiplatelet therapy—I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration.[see comment][erratum appears in BMJ 1994;308(6943):1540]. BMJ 1994;308(6921):81–106.

    Article  Google Scholar 

  16. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial.[see comment][summary for patients in Curr Cardiol Rep 2002;4(6):486–87; PMID: 12379169]. Lancet 2002;360(9326):7–22.

    Article  Google Scholar 

  17. Yusuf S. Two decades of progress in preventing vascular disease.[see comment][comment]. Lancet 2002;360(9326):2–3.

    Article  PubMed  Google Scholar 

  18. Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006;295(2):180–89.

    Article  CAS  PubMed  Google Scholar 

  19. Dunkley A, Stone M, Sayers R, Farooqi A, Khunti K. A cross sectional survey of secondary prevention measures in patients with peripheral arterial disease in primary care. Postgraduate Med J 2007;83(983):602–5.

    Article  Google Scholar 

  20. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care.[see comment]. JAMA 2001;286(11):1317–24.

    Article  CAS  PubMed  Google Scholar 

  21. McDermott MM, Hahn EA, Greenland P, Cella D, Ockene JK, Brogan D, et al. Atherosclerotic risk factor reduction in peripheral arterial disease: Results of a national physician survey. J Gen Intern Med 2002;17(12):895–904.

    Article  PubMed  Google Scholar 

  22. McDermott MM, Mehta S, Ahn H, Greenland P. Atherosclerotic risk factors are less intensively treated in patients with peripheral arterial disease than in patients with coronary artery disease. J Gen Intern Med 1997;12(4):209–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Steingart RM, Packer M, Hamm P, Coglianese ME, Gersh B, Geltman EM, et al. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators.[see comment]. N Engl J Med 1991;325(4):226–30.

    Article  CAS  PubMed  Google Scholar 

  24. Williams MA, Fleg JL, Ades PA, Chaitman BR, Miller NH, Mohiuddin SM, et al. Secondary prevention of coronary heart disease in the elderly (with emphasis on patients > or =75 years of age): An American Heart Association scientific statement from the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2002;105(14):1735–43.

    Article  PubMed  Google Scholar 

  25. Bowling A. Ageism in cardiology.[see comment]. BMJ 1999;319(7221):1353–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Birkhead JS, Weston C, Lowe D. Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004–5: Observational study. BMJ 2006;332(7553):1306–11.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial.[see comment]. Lancet 2002;360(9346):1623–30.

    Article  CAS  PubMed  Google Scholar 

  28. Simpson CR, Hannaford PC, Williams D. Evidence for inequalities in the management of coronary heart disease in Scotland. Heart 2005;91(5):630–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Lee HY, Cooke CE, Robertson TA. Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge.[see comment]. J Managed Care Pharmacy 2008;14(3):271–80.

    Article  Google Scholar 

  30. Williams D, Bennett K, Feely J. Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care. Br J Clin Pharmacol 2003;55(6):604–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cournot M, Cambou JP, Quentzel S, Danchin N. Motifs de sous-utilisation des thérapeutiques de prévention secondaire chez les coronariens de plus de 70 ans. Annales de Cardiologie et d’Angeiologie 2005;54(Suppl 1):S17-S23.

    Google Scholar 

  32. Aronow WS. Treatment of older persons with hypercholesterolemia with and without cardiovascular disease. J Gerontology Series A-Biological Sciences & Medical Sciences 2001;56(3):M138–M145.

    Article  CAS  Google Scholar 

  33. Majumdar SR, Gurwitz JH, Soumerai SB. Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease.[see comment]. J Gen Intern Med 1999;14(12):711–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Crilly M, Bundred P, Hu X, Leckey L, Johnstone F. Gender differences in the clinical management of patients with angina pectoris: A cross-sectional survey in primary care. BMC Health Serv Res 2007;7:142.

    Google Scholar 

  35. Crilly MA, Bundred PE, Leckey LC, Johnstone FC. Gender bias in the clinical management of women with angina: Another look at the Yentl syndrome. J Women’s Health 2008;17(3):331–42.

    Article  Google Scholar 

  36. Cho L, Hoogwerf B, Huang J, Brennan DM, Hazen SL. Gender differences in utilization of effective cardiovascular secondary prevention: A Cleveland clinic prevention database study. J Women’s Health 2008;17(4):515–21.

    Article  Google Scholar 

  37. Keyhani S, Scobie JV, Hebert PL, McLaughlin MA. Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits.[see comment]. Hypertension 2008;51(4):1149–55.

    Article  CAS  PubMed  Google Scholar 

  38. Simpson CR, Wilson C, Hannaford PC, Williams D. Evidence for age and sex differences in the secondary prevention of stroke in Scottish primary care. Stroke 2005;36(8):1771–75.

    Article  CAS  PubMed  Google Scholar 

  39. Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke patients. Stroke 2000;31(8):1833–37.

    Article  CAS  PubMed  Google Scholar 

  40. Kaplan RC, Tirschwell DL, Longstreth WT, Jr., Manolio TA, Heckbert SR, Lefkowitz D, et al. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly.[see comment][erratum appears in Neurology 2006;66(4):493]. Neurology 2005;65(6):835–42.

    Article  CAS  PubMed  Google Scholar 

  41. Tamblyn R, Lavoie G, Petrella L, Monette J. The use of prescription claims databases in pharmacoepidemiological research: The accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995;48(8):999–1009.

    Article  CAS  PubMed  Google Scholar 

  42. Sigvant B, Wiberg-Hedman K, Bergqvist D, Rolandsson O, Wahlberg E. Risk factor profiles and use of cardiovascular drug prevention in women and men with peripheral arterial disease. Eur J Cardiovascular Prevention & Rehabilitation 2009;16(1):39–46.

    Article  Google Scholar 

  43. Statistics Canada. Age Groups and Sex for Population of Canada (2006 Census). 2006. Accessed July 22, 2007.

    Google Scholar 

  44. Hobi A, Roy S, Vuille C, Perdrix J, Darioli R. Évolution du contrôle des facteurs de risque cardiovasculaire chez les patients coronariens de plus de 65 ans. Rev Médicale Suisse 2006;2(56):658–63.

    CAS  Google Scholar 

  45. Lovell M, Harris K, Forbes T, Twillman G, Abramson B, Criqui MH, et al. Peripheral arterial disease: Lack of awareness in Canada. Can J Cardiol 2009;25(1):39–45.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Centre de recherche sur le vieillissement, Institut universitaire de gériatrie de Sherbrooke, Sherbrooke, QC, Canada

    Mariane Pâquet MD, MSc & Danielle Pilon MD, MSc

  2. Département de médecine sociale et préventive, Université de Montréal, 1301 Sherbrooke Est, Montréal, QC, H2L 1M3, Canada

    Mariane Pâquet MD, MSc

  3. Département de médecine interne, Université de Sherbrooke, Sherbrooke, QC, Canada

    Danielle Pilon MD, MSc

  4. Département d’anesthésiologie, Université de Sherbrooke, Sherbrooke, QC, Canada

    Jean-Pierre Tétrault MD, MSc

  5. Centre de recherche clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Nathalie Carrier MSc

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  1. Mariane Pâquet MD, MSc
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Correspondence to Mariane Pâquet MD, MSc.

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Pâquet, M., Pilon, D., Tétrault, JP. et al. Protective Vascular Treatment of Patients with Peripheral Arterial Disease: Guideline Adherence According to Year, Age and Gender. Can J Public Health 101, 96–100 (2010). https://doi.org/10.1007/BF03405572

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  • DOI: https://doi.org/10.1007/BF03405572

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