Changes in preventive medical therapies and CV risk factors after CT angiography

Objectives: The aim of the study was to determine the association of coronary computed tomographic angiography (CTA)-identified coronary artery disease (CAD) with post-test aspirin, statin, and antihypertensive medication use and changes in cholesterol and blood pressure (BP). Background: The relationship of CTA findings to subsequent changes in preventive cardiovascular medication prescribing patterns and risk factors is largely unknown. Methods: We studied 1,125 consecutive patients without known CAD referred for coronary CTA. CAD was defined as none, nonobstructive (<50%), or obstructive (≥50%). Prescriptions were queried in the 6 months pre- and post-CTA for comparison of aspirin, statin, and BP treatment. Medication intensification was defined as initiation, dose increase, or, for statins, change to a more potent formulation. Lipid and BP values were obtained at 12 months pre- and post-CTA. Results: Patients were 50 ± 12 years of age (59% men), with 34%, 47%, and 33% on baseline statin, BP medication(s), and aspirin, respectively. Relative to patients without CAD (n = 617), patients with nonobstructive (n = 411) and obstructive CAD (n = 97) demonstrated significant intensification in unadjusted rates of statin (26%, 46%, and 46% of patients; p < 0.001), BP (11%, 21%, and 24%; p < 0.001), and aspirin therapies (9%, 29%, and 40%; p < 0.001), and significant improvements in total cholesterol (-6.7, -14.7, and -24.7 mg/dl; p = 0.008), low-density lipoprotein cholesterol (-5.6, -14.1, and -24.6 mg/dl; p = 0.001), systolic (+0.1, -1.4, and -4.9 mm Hg; p = 0.002), and diastolic BP (-0.6, -1.0, and -3.4 mm Hg; p = 0.012), respectively. Adjusted for baseline risk factors and medications, CAD was independently associated with increased aspirin, statin, and BP medication use rates in CTA-identified nonobstructive CAD (odds ratio [OR]: 6.9, 95% confidence interval [CI]: 4.7 to 10.2; OR: 6.6, 95% CI: 3.0 to 14.3; OR: 1.6, 95% CI: 1.1 to 2.2, respectively; p < 0.05), and aspirin and statin use in obstructive CAD (OR: 42.4, 95% CI: 15.8 to 113.9; OR: 30.3, 95% CI: 3.2 to 289.2, respectively; p < 0.05). Conclusions: CAD presence and severity on CTA are associated with increased use of preventive cardiovascular medications and improvements in cholesterol and BP.