Author + information
- Received July 31, 2012
- Revision received November 1, 2012
- Accepted November 9, 2012
- Published online May 1, 2013.
- Michael K. Cheezum, MD⁎,
- Edward A. Hulten, MD, MPH†,
- Ryan M. Smith, DO⁎,
- Allen J. Taylor, MD‡,
- Jacqueline Kircher, MD§,
- Luke Surry, MD∥,
- Matthew York¶ and
- Todd C. Villines, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Todd C. Villines, Cardiac CT Program, Walter Reed National Military Medical Center, Building 9A, Room 2335, 8901 Wisconsin Avenue, Bethesda, Maryland 20889-5600
Objectives The aim of the study was to determine the association of coronary computed tomographic angiography (CTA)–identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and changes in cholesterol and blood pressure (BP).
Background The relationship of CTA findings to subsequent changes in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown.
Methods We studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (<50%), or obstructive (≥50%). Prescriptions were queried in the 6 months pre- and post-CTA for comparison of aspirin, statin, and BP treatment. Medication intensification was defined as initiation, dose increase, or, for statins, change to a more potent formulation. Lipid and BP values were obtained at 12 months pre- and post-CTA.
Results Patients were 50 ± 12 years of age (59% men), with 34%, 47%, and 33% on baseline statin, BP medication(s), and aspirin, respectively. Relative to patients without CAD (n = 617), patients with nonobstructive (n = 411) and obstructive CAD (n = 97) demonstrated significant intensification in unadjusted rates of statin (26%, 46%, and 46% of patients; p < 0.001), BP (11%, 21%, and 24%; p < 0.001), and aspirin therapies (9%, 29%, and 40%; p < 0.001), and significant improvements in total cholesterol (−6.7, −14.7, and −24.7 mg/dl; p = 0.008), low-density lipoprotein cholesterol (−5.6, −14.1, and −24.6 mg/dl; p = 0.001), systolic (+0.1, −1.4, and −4.9 mm Hg; p = 0.002), and diastolic BP (−0.6, −1.0, and −3.4 mm Hg; p = 0.012), respectively. Adjusted for baseline risk factors and medications, CAD was independently associated with increased aspirin, statin, and BP medication use rates in CTA-identified nonobstructive CAD (odds ratio [OR]: 6.9, 95% confidence interval [CI]: 4.7 to 10.2; OR: 6.6, 95% CI: 3.0 to 14.3; OR: 1.6, 95% CI: 1.1 to 2.2, respectively; p < 0.05), and aspirin and statin use in obstructive CAD (OR: 42.4, 95% CI: 15.8 to 113.9; OR: 30.3, 95% CI: 3.2 to 289.2, respectively; p < 0.05).
Conclusions CAD presence and severity on CTA are associated with increased use of preventive cardiovascular medications and improvements in cholesterol and BP.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The views expressed here are those of the authors' only, and are not to be construed as those of the Department of Defense or the United States Government.
- Received July 31, 2012.
- Revision received November 1, 2012.
- Accepted November 9, 2012.
- American College of Cardiology Foundation