Article

The implementation of evidence-based secondary medical prevention in
peripheral arterial disease (PAD) patients has received increasing attention in
recent years, but population-based data are sparse. This study examined the use
of secondary medical prophylaxis in unselected symptomatic PAD patients in
Denmark. DESIGN: A nationwide follow-up study based on individual-level record
linkages of population-based healthcare registers was performed. PARTICIPANTS:
All patients who underwent primary vascular reconstruction in Denmark between
1996 and 2006 with a minimum of 6 months of follow-up were included (n = 16,492).
METHODS: Data were obtained from prescriptions that were filled six months after
primary vascular reconstruction (+/-90 days). The use of secondary medical
prevention was examined according to calendar year and place of residence.
RESULTS: The use of lipid-lowering drugs increased from 32.2% in 1996 to 76.1% in
2006 (adjusted relative risk (RR) 1.95, 95% CI 1.81-2.10). The overall use of
antihypertensive therapy was unchanged during the study period, but treatment
shifted from diuretics/calcium antagonists towards angiotensin-converting enzyme
inhibitors and angiotensin II receptor antagonists. The use of combination
therapy (concomitant lipid-lowering, antiplatelet and any antihypertensive
therapies) increased from 29.1% in 1996 to 67.6% in 2006 (adjusted RR 1.95, 95%
CI 1.80-2.12). This shift in the use of secondary medical prevention was
independent of sociodemographic and clinical factors. No substantial differences
in pharmacological use based on place of residence were observed. CONCLUSION: The
use of evidence-based secondary medical prevention, especially lipid-lowering
drugs, increased substantially among symptomatic PAD patients in Denmark from
1996 to 2006. However, recommendations in current clinical guidelines suggest
that room for improvement remains.

Langue : ANGLAIS