Secondary medical prevention after primary vascular surgery between 1996 and 2006: a shift towards more evidence-based treatment

Eur J Prev Cardiol. 2013 Oct;20(5):763-70. doi: 10.1177/2047487312449592. Epub 2012 May 25.


Objective: The implementation of evidence-based secondary medical prevention in peripheral arterial disease (PAD) patients has received increasing attention in recent years, but population-based data are sparse. This study examined the use of secondary medical prophylaxis in unselected symptomatic PAD patients in Denmark.

Design: A nationwide follow-up study based on individual-level record linkages of population-based healthcare registers was performed.

Participants: All patients who underwent primary vascular reconstruction in Denmark between 1996 and 2006 with a minimum of 6 months of follow-up were included (n = 16,492).

Methods: Data were obtained from prescriptions that were filled six months after primary vascular reconstruction (±90 days). The use of secondary medical prevention was examined according to calendar year and place of residence.

Results: The use of lipid-lowering drugs increased from 32.2% in 1996 to 76.1% in 2006 (adjusted relative risk (RR) 1.95, 95% CI 1.81-2.10). The overall use of antihypertensive therapy was unchanged during the study period, but treatment shifted from diuretics/calcium antagonists towards angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The use of combination therapy (concomitant lipid-lowering, antiplatelet and any antihypertensive therapies) increased from 29.1% in 1996 to 67.6% in 2006 (adjusted RR 1.95, 95% CI 1.80-2.12). This shift in the use of secondary medical prevention was independent of sociodemographic and clinical factors. No substantial differences in pharmacological use based on place of residence were observed.

Conclusion: The use of evidence-based secondary medical prevention, especially lipid-lowering drugs, increased substantially among symptomatic PAD patients in Denmark from 1996 to 2006. However, recommendations in current clinical guidelines suggest that room for improvement remains.

Keywords: Nationwide follow up study; peripheral arterial disease; secondary medical prevention; vascular surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Denmark
  • Drug Prescriptions
  • Drug Therapy, Combination
  • Drug Utilization Review / trends
  • Evidence-Based Medicine / trends*
  • Female
  • Follow-Up Studies
  • Guideline Adherence / trends
  • Humans
  • Hypolipidemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / surgery*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / trends*
  • Quality Improvement / trends
  • Quality Indicators, Health Care / trends
  • Registries
  • Secondary Prevention / methods
  • Secondary Prevention / trends*
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures*


  • Antihypertensive Agents
  • Hypolipidemic Agents
  • Platelet Aggregation Inhibitors