Changes in Medical Therapy and Lifestyle After Anatomical or Functional Testing for Coronary Artery Disease

Abstract

Background: 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.

Methods and results: 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.

Conclusions: 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.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550.

Keywords: angina; coronary disease; diagnosis; prevention.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1

Changes in preventive medical therapy and lifestyle practices from baseline to 60‐day visit (unadjusted). ACEi indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; CTA, computed tomographic angiography.

Figure 2

Adjusted odds ratios of preventive medical therapy and lifestyle practices at 60‐day visit, comparing anatomical testing (computed tomographic angiography) to functional testing (adjusted for patients’ demographic and clinical characteristics and physician specialty). Note: Odds ratios for smoking and overweight/obese status were inverted to represent beneficial outcomes (smoking abstinence and normal weight, respectively) and retain consistency with other beneficial measures in the figure. ACEi indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker.