Secondary prevention of coronary artery disease in urban Indian primary care

Background: Although secondary prevention has the potential to substantially reduce the risk of coronary events, its impact depends on the extent to which it is applied in the community. Presently, there is no information on the frequency with which drugs recommended for secondary prevention of CAD are used in the setting of primary care in India or other developing countries. Such information could help focus attention of physicians on its importance. Method: In a prospective epidemiologic survey, 134 primary care physicians from 50 randomly selected cities distributed throughout India identified outpatients with stable CAD and symptoms of angina. Demographic and clinical characteristics, together with their treatment were recorded on a standardized questionnaire. Results: In 406 patients, the number (%, 95% CI) receiving aspirin was, 335 (82.5, 78.2 to 86.2); b-blockers, 215 (53.0, 48.1 to 57.9); angiotensin converting enzyme inhibitors (ACEI), 63 (15.5, 12.0 to 19.0); and statins, 280 (69.0, 61.0 to 77.0). Hypertension was untreated in 125 patients (33.4, 28.6 to 38.2). Combination treatment with any two (of aspirin, b-blocker, statin, ACEI, or antihypertensive agent other than b-blocker and ACEI) was received by 249 patients (61.3, 51.3 to 71.3); and with any three by 21 (5.2, 3.0 to 7.3). Discussion: Secondary prevention is under utilized in Indian patents with CAD. Against the background of an emerging epidemic, physicians in primary care need to increase the use of widely available specific secondary preventive agents recommended by guidelines. (C) 2008 Published by Elsevier Ireland Ltd.