Preoperative cardiovascular risk factor control in elective coronary artery bypass graft patients: A failure of present management

Background: After coronary artery bypass graft (CABG) patients are at high risk for disease progression and future cardiac events. Risk factor control can reduce subsequent clinical events and mortality. The appropriateness of cardiovascular risk factor management in CABG patients is largely unknown. Objectives: To evaluate the presence of cardiovascular risk factors, their treatment and the adequacy of that treatment in patients just before elective CABG. Patients and methods: Over a six-month period in 1999, 120 patients who underwent elective CABG at a single centre were assessed. All patients were assessed for the presence of important, known, modifiable cardiovascular risk factors (smoking, hypertension, hypercholesterolemia, obesity and diabetes), and the adequacy of the control of these risk factors, as determined by published consensus conference guidelines. Results: Ninety-five per cent of patients were receiving treatment for their risk factors. Twenty of 86 patients had their hyperlipidemia controlled, only 10 of 36 patients with diabetes had their glucose well controlled, 56 of 82 patients had adequate control of their hypertension, 21 of 120 patients were current smokers, 78 of 120 patients were obese and only 13 of 120 patients had all risk factors under control. Conclusions: As expected, the prevalence of all the risk factors was very high. Despite a high level of medical treatment, risk factor management was very poor. More effort needs to go into active, long term management, and patient education and motivation, if any substantial progress is to be made in reducing future cardiac events in patients after CABG.