Underuse of recommended secondary preventive therapies in current routine clinical practice

Aims: Recommendations on the use of antithrombotic agents, antihypertensive drugs and statin for secondary prevention of coronary artery (CAD), ischemic cerebrovacular (CVD), and peripheral arterial (PAD) diseases are now well established. However, there may be a gap between clinical practice and evidence-based guidelines. We aimed to investigate the premorbid use of secondary prevention medications in patients with recurrent cardiovascular events. Methods and results: We prospectively recorded all patients with CVD and CAD in Dijon, France from 2006 to 2010. Data about medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predictors of the use of medications in patients with previous cardiovascular disease. Among the 2126 patients included (1270 CVD and 856 CAD), 867 (40.8%) had a history of cardiovascular diseases including 448 (51.7%) with prior CVD only, 191 (22.0%) with prior CAD only, 68 (7.8%) with prior PAD only, and 160 (18.5%) with polyvascular disease. In these patients, 57.3% were on antithrombotic therapy, 61.2% were treated with antihypertensive drugs, 32.9% received statins, and only 23.6% were on an optimal regimen, defined as the combination of the three therapies. Compared with patients with previous CAD only, those with previous CVD only were less likely to be receiving each of these treatments or to receive an optimal regimen (OR=0.17, p<0.001). Conclusion: This study highlighted the underuse of recommended secondary preventive therapies in current clinical practice. Underuse was particularly pronounced in patients with previous CVD. These findings may account for the burden of recurrent events.