Achievement of Optimal Medical Therapy Goals for US Adults With Coronary Artery Disease: Results From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Study Questions:

What proportion of community-dwelling patients in a nonclinical trial setting and with self-reported coronary artery disease (CAD) achieve optimal risk factor levels?

Methods:

This was a post-hoc analysis of 3,167 participants with CAD in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national prospective cohort study in which community-dwelling adults were enrolled from 2003 to 2007. The authors calculated the proportion of these participants with self-reported CAD who met seven risk factor goals (based on the COURAGE trial): 1) aspirin use; 2) systolic blood pressure <130 mm Hg and diastolic blood pressure <85 mm Hg (<80 mm Hg if diabetic); 3) low-density lipoprotein cholesterol <85 mg/dl, high-density lipoprotein cholesterol >40 mg/dl, and triglycerides <150 mg/dl; 4) fasting glucose <126 mg/dl (glycated hemoglobin was not measured in the REGARDS study); 5) nonsmoking status; 6) body mass index <25 kg/m2; and 7) exercise ≥4 days per week. These data were collected at baseline examination.

Results:

An average of 3.6 ± 1.2 of the seven total possible risk factor goals was met; the median number of goals met was four. Fewer than 25% of patients with prevalent CAD met five or more goals. Only 17 of the 3,167 participants (0.5%) met all seven goals. The following were independently associated with meeting more goals: older age, white race, higher income, more education, and higher physical functioning.

Conclusions:

In an analysis of community-dwelling individuals with self-reported CAD, approximately four out of a possible seven risk factor goals (studied in the COURAGE trial) were met. And, <1% of individuals achieved all seven risk factor goals.

Perspective:

This is an important contribution that buttresses the observation that there is a substantial opportunity to improve the risk factor profiles of individuals with CAD. Highlighting disparities in the realization of risk factor goals, the authors also provide insight into particularly vulnerable populations who may benefit from concentrated efforts on risk factor reduction.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Interventions and Coronary Artery Disease, Exercise

Keywords: Coronary Artery Disease, Stroke, Risk Reduction Behavior, Exercise, European Continental Ancestry Group, Risk Factors, Blood Pressure, Angioplasty, Balloon, Coronary, Hemoglobin A, Glycosylated, Cholesterol, Body Mass Index, Cholesterol, HDL, Triglycerides, Diabetes Mellitus, Drug Evaluation


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