THE FACTORS ASSOCIATED WITH PRESCRIPTION OF CARDIOVASCULAR PREVENTIVE TREATMENT IN PATIENTS WITH LOWER EXTREMITIES ATHEROSCLEROSIS

Aim. To assess the factors associated with combination cardio protection therapy intake in patients with atherosclerotic lesion of lower extremities. Material and methods. Totally, 436 patients studied: 372 (82,3%) males and  64 (14,7%) females  at the age  45-81  (mediana  63) year old with obliteration  atherosclerosis of lower extremities  >50%.  Patients  were investigated under the framework of the registry in Kemerovo cardiological center in 2009-2013 y. The study included a dynamic follow-up of vascular surgeon and cardiologist, instrumental and laboratory investigation. Depending on the regularity of cardioprotection  therapy, two groups were shaped:  group 1 (n=226) taking full combination cardioprotection therapy: antiplatelets,  inhibitors of angiotensin-converting  enzyme or angiotensin receptor blockers and statins, group 2 (n=210) did not take at least one of the listed drug groups.

Results. The intake of combination  cardioprotection  therapy  was associated with higher prevalence  of arterial hypertension (95,1%), myocardial infarction (46,5%), coronary bypass  and percutaneous coronary intervention (21,1% and 32,3%, resp.), as interventions on extracranial arteries  (12,8%). Patients  from this group had angina presentation    more   often   and   the   diagnosed    coronary   heart disease  — 68,1%  and  83,2%,  resp.  Almost 60% of patients  with adequately  prescribed  treatment  were followed-up by cardiologist. In laboratory  data  of  this  group  there  was  lower  level  of  total  cholesterol. Patients had significantly larger left ventricle and lower ejection fraction.

Conclusion. The factors associated with optimal medication treatment were ischemic heart disease (p<0,001), cardiologist follow-up (p<0,001), decrease of total cholesterol (p=0,02). To increase the effectiveness of secondary prevention in obliteration atherosclerosis of lower extremities it is worthy to apply novel organizational approaches  during outpatient period, particularly, dispensary follow-up in cardiologist practice.

1. National recommendations for treatment of patients with lower extrermities arteries disease. Moscow, 2013, p 74. Russian (Национальные рекомендации по ведению пациентов с заболеваниями артерий нижних конечностей. Москва 2013; 74 с).

2. Gallino A, Aboyans V, Diehm C, et al.; European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. Eur Heart J 2014; 35(17): 1112-9.

3. Sumin AN, Korok EV, Panfilov SD, et al. Myocardial Revascularization before Abdominal Aortic Surgery in Patients with Ischemic Heart Disease. Kardiologiia 2013; 4: 62-7. Russian (Сумин А. Н., Корок Е. В., Панфилов С. Д. и др. Реваскуляризация миокарда у больных ишемической болезнью сердца перед операциями на брюшной аорте. Кардиология 2013; 4: 62-7).

4. Arakelyan VS, Bortnikova NV, Papitashvili VG. Impact of cardiac risk factors on treatment strategy for patients with coronary artery disease and aortoiliac lesions. Complex Issues of Cardiovascular Diseases 2013; 4: 77-82. Russian (Аракелян В. С., Бортникова Н. В., Папиташвили В. Г. Оценка влияния кардиальных факторов риска на тактику лечения больных с сочетанным атеросклеротическим поражением аорто-подвздошного сегмента и коронарных артерий. Комплексные проблемы сердечно-сосудистых заболеваний 2013; 4: 77-82).

5. Sumin AN, Korok EV, Panfilov SD. Preventive myocardial revascularization before abdominal aortic interventions: long-term results. Russ J Cardiol 2013; 104(6): 11-6. Russian (Сумин А. Н., Корок Е.В., Панфилов С. Д. и др. Использование стратегии с превентивной реваскуляризацией миокарда перед операциями на брюшной аорте: отдаленные результаты. Российский кардиологический журнал 2013; 104(6): 11-6).

6. European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. The Task Force on the Diagnosis and Treat. Eur Heart J 2011; 32(22): 2851-906.

7. Kumbhani DJ, Steg PG, Cannon CP, et al. REACH Registry Investigators. Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. Eur Heart J 2014; 35(41): 2864-72. 38

8. Armstrong EJ, Chen DC, Westin GG, et al. Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease. J Am Heart Assoc 2014; 3(2):e000697.

9. Montminy ML, Gauvin V, Turcotte S, et al. Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease. PLoS One 2016; 11(2): e0148069.

10. Welten GM, Schouten O, Hoeks SE, et al. Long-term prognosis of patients with peripheral arterial disease: a comparison in patients with coronary artery disease. JACC 2008; 51(16): 1588-96.

11. Cacoub PP, Abola MTB, Baumgartner I, et al. Cardiovascular risk factor control and outcomes in peripheral artery disease patients in the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Atherosclerosis 2009; 204(2): e86-92.

12. Kundhal KK, Chin SL, Harrison L, et al. Patterns of medical therapy in patients with peripheral artery disease in a tertiary care centre in Canada. Can J Cardiol Elsevier 2007; 23(5): 357-61.

13. Subherwal S, Patel MR, Kober L, et al. Missed Opportunities: Despite Improvement in Use of Cardioprotective Medications Among Patients With Lower-Extremity Peripheral Artery Disease, Underuse Remains. Circulation 2012; 126(11): 1345-54.

14. Ardati AK, Kaufman SR, Aronow HD, et al. The Quality and Impact of Risk Factor Control in PatientsWith Stable Claudication Presenting for Peripheral Vascular Interventions. Circ Cardiovasc Interv 2012; 5(6): 850-5.

15. Lonchakova IYu, Makarov SA, Artamonova GB, et al. Organizational aspects of managing patients with atherosclerosis obliterans of lower-limb vessels at an ambulatory stage. Angiology and Vascular Surgery 2015; 3: 38-42. Russian (Лончакова И. Ю., Макаров С. А., Артамонова Г. В. и др. Организационные аспекты лечения больных с облитерирующим атеросклерозом сосудов нижних конечностей на амбулаторном этапе. Ангиология и сосудистая хирургия 2015; 3: 38-42).