Due to the limited number of included trials , there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA .
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease .
However , the role of prophylaxis in individuals with abdominal aortic aneurysm ( AAA ) remains unclear .
Several studies have shown that despite successful repair , those people with AAA have a poorer rate of survival than healthy controls .
People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events .
Despite this association , little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA .
This is an up date of a Cochrane review first published in 2014 .
OBJECTIVES To determine the long-term effectiveness of antiplatelet , antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm ( AAA ) .
Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control?
OBJECTIVES The purpose of this study was to assess the value of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate ( HR ) control scheduled for major vascular surgery . BACKGROUND Treatment guidelines of the American College of Cardiology/American Heart Association recommend cardiac testing in these patients to identify subjects at increased risk . This policy delays surgery , even though test results might be redundant and beta-blockers with tight HR control provide sufficient myocardial protection . Furthermore , the benefit of revascularization in high-risk patients is ill-defined . METHODS All 1,476 screened patients were stratified into low-risk ( 0 risk factors ) , intermediate-risk ( 1 to 2 risk factors ) , and high-risk ( > or =3 risk factors ) . All patients received beta-blockers . The 770 intermediate-risk patients were r and omly assigned to cardiac stress-testing ( n = 386 ) or no testing . Test results influenced management . In patients with ischemia , physicians aim ed to control HR below the ischemic threshold . Those with extensive stress-induced ischemia were considered for revascularization . The primary end point was cardiac death or myocardial infa rct ion at 30-days after surgery . RESULTS Testing showed no ischemia in 287 patients ( 74 % ) ; limited ischemia in 65 patients ( 17 % ) , and extensive ischemia in 34 patients ( 8.8 % ) . Of 34 patients with extensive ischemia , revascularization before surgery was feasible in 12 patients ( 35 % ) . Patients assigned to no testing had similar incidence of the primary end point as those assigned to testing ( 1.8 % vs. 2.3 % ; odds ratio [ OR ] 0.78 ; 95 % confidence interval [ CI ] 0.28 to 2.1 ; p = 0.62 ) . The strategy of no testing brought surgery almost 3 weeks forward . Regardless of allocated strategy , patients with a HR < 65 beats/min had lower risk than the remaining patients ( 1.3 % vs. 5.2 % ; OR 0.24 ; 95 % CI 0.09 to 0.66 ; p = 0.003 ) . CONCLUSIONS Cardiac testing can safely be omitted in intermediate-risk patients , provided that beta-blockers aim ing at tight HR control are prescribed
Due to the limited number of included trials , there is insufficient evidence to draw any conclusions about the effectiveness of cardiovascular prophylaxis in reducing mortality and cardiovascular events in people with AAA .
BACKGROUND Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease .
However , the role of prophylaxis in individuals with abdominal aortic aneurysm ( AAA ) remains unclear .
Several studies have shown that despite successful repair , those people with AAA have a poorer rate of survival than healthy controls .
People with AAA have an increased prevalence of coronary heart disease and risk of cardiovascular events .
Despite this association , little is known about the effectiveness of pharmacological prophylaxis in reducing cardiovascular risk in people with AAA .
This is an up date of a Cochrane review first published in 2014 .
OBJECTIVES To determine the long-term effectiveness of antiplatelet , antihypertensive or lipid-lowering medication in reducing mortality and cardiovascular events in people with abdominal aortic aneurysm ( AAA ) .