Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease.

BACKGROUND:Guidelines recommend that patients with peripheral arterial disease should be medically treated to reduce the occurrence of serious cardiovascular events. Despite these recommendations, studies conducted in the early 2000s reported that medical therapies for secondary cardiovascular prevention are not given systematically to patients with peripheral arterial disease (PAD). We identified factors associated with the prescription of preventive therapies in patients with symptomatic PAD. METHODS AND FINDINGS:Consecutive patients with symptomatic peripheral arterial disease (n = 362) treated between 2008 and 2010 in one tertiary care center (CHU de Quebec, Canada) were considered. Data were collected from the medical charts. The main outcome was the combined prescription of three therapies: 1) statins, 2) antiplatelets, 3) angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. The mean age was 70 years and 43% had a pre-existing coronary artery disease. Antiplatelet therapy was the most prescribed drug (83%). A total of 52% of the patients received the three combined therapies. Less than 10% of patients had a known contraindication to one class of medication. Having at least three cardiovascular risk factors (Odds Ratio (OR) = 4.51; 95% CI: 2.76-7.37) was the factor most strongly associated with the prescription of the combined therapies. Pre-existing coronary artery disease (OR = 2.28; 95% CI: 1.43-3.65) and history of peripheral vascular surgery (OR = 2.30; 95% CI: 1.37-3.86) were two factors independently associated with the prescription of the combined therapies. However, peripheral arterial disease patients with chronic critical limb ischemia were less likely to receive the combined therapies (OR = 0.53; 95% CI: 0.32-0.87) than those with claudication. The retrospective nature of this study, not allowing for an exhaustive report of the contraindication to medication prescription, is the main limitation. CONCLUSION:About half of the patients with peripheral arterial disease were not optimally managed. Patients with multiple cardiovascular risk factors were more likely to receive the combined therapies. We still need to better understand the barriers and facilitators to the application of the guidelines

Typology of planktonic food webs and associated emerging properties as indicators of the ecological status of a permanently disturbed Gulf of Gabès

International audienceThis study highlights the importance of coupling the typology of planktonic food webs and their emerging properties to better describe the ecological status of an ecosystem under permanent disturbance mainly caused by phosphate industry. Linear inverse models were built to describe four stations under various levels of nutrient pressure, using the Markov Chain Monte Carlo method to estimate known and unknown carbon flows, later used to calculate food web typology ratios. Ecological network analysis (ENA) was used to describe the structural and functional properties of each food web. Based on the food web typology ratios, three planktonic trophic pathways (PTP) with different functional indices were distinguished according to nutrient stress. The microbial food web dominated in the least nutrient-rich environment. It mainly relied on phytoplankton production (picophytoplankton 10 µm) and channeled to higher trophic levels by herbivorous protozooplankton and metazooplankton. In the other two stationsmoderately nutrient-rich systemsthe PTP acted as a multivorous food web. Phytoplankton (small and large size fractions) and non-living components (detritus and dissolved organic carbon) played a significant role in carbon production, and competed with protozooplankton and metazooplankton for its transport. ENA indices revealed that the herbivorous food web, with the highest total system throughput and lowest relative Ascendency and cycling, was the most active but the least organized and stable system. In contrast, the microbial food web, with the lowest total system flux and highest Ascendency, was least active but more organized than the herbivorous food web. The multivorous food web displayed the most recycling and most organized system, with high values of the detritivory-to-herbivory ratio, cycling and Ascendency. In addition to ENA indices, which are considered effective tools for studying the structural and functional properties of food webs, marine ecosystem management efforts heavily focus on using the “marine food web” as a descriptor of the system’s ecological status. However, we suggest thatthe combination of food web typology and ecological indices could be used as an effective tool for the management and assessment of ecosystem health wherever possible, as well as for the study of anthropogenic pressures

Prescription of the recommended therapy.

<p>ACEI, angiotensin-converting-enzyme inhibitor; ARB, angiotensin receptor blocker; CAD, coronary artery disease; PAD, peripheral arterial disease.</p

Patient’s demographics and clinical characteristics (n = 362).

<p>Patient’s demographics and clinical characteristics (n = 362).</p

Factors associated with the prescription of the recommended therapies in multivariate analysis.

<p>Factors associated with the prescription of the recommended therapies in multivariate analysis.</p