Suboptimal control of atherosclerotic disease risk factors after cardiac and cerebrovascular procedures

Background and Purpose - Undergoing a carotid endarterectomy, a coronary artery bypass graft, or a percutaneous coronary intervention provides an opportunity to optimize control of blood pressure and low-density lipoprotein. Methods - Using Veterans Administration databases, we determined whether patients who underwent a carotid endarterectomy (n = 252), coronary artery bypass graft ( n = 486), or percutaneous coronary intervention ( n = 720) in 2002 to 2003 at 5 Veterans Administration Healthcare Systems had guideline-recommended control of blood pressure and low-density lipoprotein in 12-month periods before and after a vascular procedure. Postprocedure control of risk factors across procedure groups was compared using chi(2) tests and multivariate logistic regression. Results - The proportion of patients undergoing carotid endarterectomy who had optimal control of both blood pressure and low-density lipoprotein increased from 23% before the procedure to 33% after the procedure ( P = 0.05) compared with increases from 32% to 43% for coronary artery bypass graft ( P = 0.001) and from 29% to 45% for percutaneous coronary intervention ( P = 0.002). Compared with the carotid endarterectomy group, the percutaneous coronary intervention group was more likely to achieve optimal control of blood pressure ( OR: 1.92, 95% CI: 1.42 to 2.59) or low-density lipoprotein ( OR: 1.51, 95% CI: 1.01 to 2.26) and the coronary artery bypass graft group was more likely to achieve optimal control of blood pressure ( OR: 1.53, 95% CI: 1.42 to 2.59). Postprocedure cardiology visits, increase in medication intensity, and greater frequency of outpatient visits were also associated with optimal postprocedure risk factor control. Conclusions - Although modest improvements in risk factor control were detected, a majority of patients in each vascular procedure group did not achieve optimal risk factor control. More effective risk factor control programs are needed among most vascular procedure patients.