Management of risk factors: a survey of New Zealand vascular surgeons

Aim Patients with peripheral occlusive arterial disease (POAD) suffer significant morbidity and mortality from cardiovascular events that may be reduced by appropriate risk factor management. The aim of this study was to document the opinion of New Zealand vascular surgeons regarding risk factor management in patients with POAD. Methods A questionnaire was emailed to 42 New Zealand vascular surgeons. Surgeons were asked if they checked risk factors in patients with POAD and who they thought should manage these risk factors. The survey was then re-emailed to non-responders after 3 weeks and subsequently posted to the remaining non-responders with a reply paid envelope after a further 3 weeks. Results The overall response rate was 83% (35/42). Thirty-four of the 35 surgeons (97%) stated that they routinely asked smoking history, 69% monitored blood pressure, 74% checked cholesterol level, 57% checked blood glucose level, and none checked homocysteine level, although 43% consider hyperhomocysteinaemia to be a risk factor for atherosclerosis. Vascular surgeons considered general practitioners should play a pivotal role in the management of cardiovascular risk factors. A variable proportion of vascular surgeons thought that the vascular team should also be involved in the management of smoking (46%), hyperlipidaemia (20%), hyperhomocysteinaemia (23%), and prescription of antiplatelet therapy (69%). Conclusions Modification of risk factors in patients with POAD is imperative but opinion on who is responsible for risk factor management lacks consensus. It is more important that risk factor modification occurs than who oversees such intervention.