Changes in Medical Therapy and Lifestyle After Anatomical or Functional Testing for Coronary Artery Disease.
Changes in Medical Therapy and Lifestyle After Anatomical or Functional Testing for Coronary Artery Disease.
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DOI：
10.1161/jaha.116.003807
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发表时间：
2016-10-12
影响因子：
5.4
通讯作者：
Douglas PS
中科院分区：
文献类型：
--
作者：
Ladapo JA;Hoffmann U;Lee KL;Coles A;Huang M;Mark DB;Dolor RJ;Pelberg RA;Budoff M;Sigurdsson G;Severance HW;Douglas PS
对新出现冠状动脉疾病症状的患者进行诊断检测可能会影响危险因素的管理，而与检测类型或检测结果无关。然而，在解剖或功能测试后，对药物和生活方式的变化知之甚少。我们在10003名有症状的患者（53%为女性，平均年龄61岁）中随机分配到冠状动脉计算机断层血管造影或功能检查组（NCT01174550），研究了在60天内影响预防性药物治疗和生活方式的因素。我们还评估了预防性改变与主要心血管事件的关系。基线时用药/生活方式没有差异。在第60天，相对于基线，与功能测试（P<0.0001）相比，计算机断层血管造影策略与新开始使用阿司匹林（11.8%对7.8%），他汀类药物（12.7%对6.2%）和β受体阻滞剂（8.1%对5.3%）的患者比例较高相关（P<0.0001）。在超重/肥胖患者开始运动、戒烟或体重减轻方面，计算机断层血管成像和功能测试策略之间没有显著差异，尽管计算机断层血管成像后健康饮食的总体患病率较高（P=0.002），而肥胖/超重状态较低（P=0.040）。初步试验阳性结果和血运重建与预防性药物和生活方式的相关性强于试验类型。开始用药与减少心血管事件无关。初步检测结果阳性和血运重建是预防性医疗和生活方式改变的主要驱动因素，检测类型起次要作用。然而，仍有大量机会进一步降低心血管风险。URL: https://www.clinicaltrials.gov。唯一标识符：NCT01174550。
Diagnostic testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or functional testing. We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical testing with coronary computed tomographic angiography or functional testing (NCT01174550). We also assessed the association of preventive changes with major cardiovascular events. There were no differences in medications/lifestyle at baseline. At 60 days, relative to baseline, the computed tomographic angiography strategy was associated with a higher proportion of patients newly initiating aspirin (11.8% versus 7.8%), statins (12.7% versus 6.2%), and β‐blockers (8.1% versus 5.3%), compared to functional testing (P<0.0001 for each). No significant differences between computed tomographic angiography and functional testing strategies were observed for initiation of exercise, quitting smoking, or weight loss in overweight/obese patients, though overall prevalence of healthy eating was higher after computed tomographic angiography (P=0.002) while obese/overweight status was lower (P=0.040). Positive initial test results and revascularization demonstrated stronger associations with preventive medications and lifestyle than test type. Medication initiation was not associated with fewer cardiovascular events. Positive initial test results and revascularization are primary drivers of changes in preventive medical and lifestyle practices, with test type making secondary contributions. However, substantial opportunities exist to further reduce cardiovascular risk. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.