Antiplatelet and lipid-lowering therapies for the secondary prevention of cardiovascular disease: Are we doing enough?

OBJECTIVE: To evaluate whether current recommendations with respect to the treatment of dyslipidemias and the use of antiplatelet agents are being app lied in the secondary prevention of cardiovascular disease in primary care settings. DESIGN: Descriptive study based on data from the FAMUS (FAmily Medicine, Un iversite de Sherbrooke) primary care register. SETTING AND PARTICIPANTS: Two-hundred and thirty-three physicians participa ting in the FAMUS project contributed information from nonpregnant patients over 20 years of age consulting for a periodic health examination between 1992 and 1996. INTERVENTIONS: Data from patients in secondary prevention (those with or ha ving had angina, a previous myocardial infarction, bypass surgery, coronary angioplasty or peripheral vascular disease) were extracted and analyzed. MAIN RESULTS: Of the 52,505 patients in the register, 4315 (8%) were identi fied as being in secondary prevention. Overall, 53% were noted as receiving an antiplatelet agent while 4% were taking warfarin therapy. Only 64% (278 0) had a complete lipid profile on record while 38% were being treated with a hypolipidemic agent. In the treated group, only 30% had a low density li poprotein cholesterol level below 3.0 mmol/L compared with 22% in the untre ated group. CONCLUSIONS: A large number of patients identified as being in secondary pr evention were not screened for dyslipidemias, and, of those who were, the m ajority were undertreated according to current recommendations. Antiplatele t agents were more widely prescribed but potentially underused.