Guideline directed medical therapy for secondary prevention after coronary artery bypass grafting

Deo, Salil Vasudeo (2025) Guideline directed medical therapy for secondary prevention after coronary artery bypass grafting. PhD thesis, University of Glasgow.

Abstract

Atherosclerotic cardiovascular disease, and specifically coronary artery disease is a major cause of mortality and morbidity in the Unites States. A large proportion of patients with atherosclerotic cardiovascular disease receive coronary artery bypass grafting. However, despite this surgical intervention, patients are at continued risk for progression of atherosclerosis, both in their native coronary arteries as well as the conduits used for the coronary artery bypass surgery. Patients also have other cardiovascular risk factors, specifically diabetes, obesity, and many have poly-vascular disease. The American Heart Association has recommendations for pharmacotherapy in these patients, which is termed as guideline directed medical therapy for secondary prevention of cardiovascular disease.

The US Department of Veteran Affairs is the single largest unified healthcare system in the United States and supports the healthcare needs of approximately 9 million US Veterans. These people are older, more frail, and have more cardiovascular risk factors than the average US population. All these conditions put them at higher risk for recurrent cardiovascular events after receiving coronary artery bypass surgery.

Therefore, the overarching aim of my PhD was to study the use of guideline directed medical therapy and factors associated with non-use among US Veterans. To achieve this aim, six papers were completed and included in this thesis. The broad synopsis of the thesis is that guideline directed medical therapy does improve cardiovascular outcomes. However, the present use of these therapies among US Veterans is suboptimal; additionally, some reasons for non-use were identified. Therefore, in conclusion, more work needs to be done to ensure improved use of these life-saving therapies.

Links to the articles.
Manuscripts included in this thesis:

Deo SV, Al-Kindi S, Motairek I, McAllister D, Shah ASV, Elgudin YE, Gorodeski EZ, Virani S, Petrie MC, Rajagopalan S, Sattar N. Impact of Residential Social Deprivation on Prediction of Heart Failure in Patients With Type 2 Diabetes: External Validation and Recalibration of the WATCH DM Score Using Real World Data. Circ Cardiovasc Qual Outcomes. 2024 Mar;17(3):e010166. doi: 10.1161/CIRCOUTCOMES.123.010166. Epub 2024 Feb 8. PMID: 38328913; PMCID: PMC11093755.

Deo SV, Althouse A, Al-Kindi S, McAllister DA, Orkaby A, Elgudin YE, Fremes S, Chu D, Visseren FLJ, Pell JP, Sattar N. Validating the SMART2 Score in a Racially Diverse High-Risk Nationwide Cohort of Patients Receiving Coronary Artery Bypass Grafting. J Am Heart Assoc. 2023 Nov 7;12(21):e030757. doi: 10.1161/JAHA.123.030757. Epub 2023 Oct 27. PMID: 37889195; PMCID: PMC10727407.

Deo SV, McAllister D, LaForest S, Altarabsheh S, Elgudin YE, Dunlay S, Singh S, Parikh S, Sattar N, Pell JP. Disparities in PCSK9 Initiation Among US Veterans with Peripheral Arterial Disease or Cerebrovascular Disease. Am J Cardiovasc Drugs. 2023 May;23(3):311-321. doi: 10.1007/s40256-023-00576-7. Epub 2023 Mar 22. PMID: 36947397.

Deo S, Ueda P, Sheikh AM, Altarabsheh S, Elgudin Y, Rubelowsky J, Cmolik B,
Hawkins N, McAllister D, Ruel M, Sattar N, Pell J. Lipid Lowering in "Very High Risk" Patients Undergoing Coronary Artery Bypass Surgery and Its Projected Reduction in Risk for Recurrent Vascular Events: A Monte Carlo Stepwise Simulation Approach. J Cardiovasc Pharmacol. 2023 Feb 1;81(2):120-128. doi:10.1097/FJC.0000000000001374. PMID: 36315474.

Deo SV, McAllister DA, Al-Kindi S, Elgudin Y, Chu D, Pell J, Sattar N.
Trends in Prescriptions of Cardioprotective Diabetic Agents After Coronary
Artery Bypass Grafting Among U.S. Veterans. Diabetes Care. 2022 Dec
1;45(12):3054-3057. doi: 10.2337/dc22-0570. PMID: 36256925.

Deo SV, Marsia S, McAllister DA, Elgudin Y, Sattar N, Pell JP. The time-varying cardiovascular benefits of glucagon-like peptide-1 receptor agonist therapy in patients with type 2 diabetes mellitus: Evidence from large multinational trials. Diabetes Obes Metab. 2022 Aug;24(8):1607-1616. doi: 10.1111/dom.14738. Epub 2022 May 23. PMID: 35491516; PMCID: PMC9540124

and other selected manuscripts published during the PhD period.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RC Internal medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Supervisor's Name: Pell, Professor Jill
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85379
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 12 Aug 2025 10:41
• Last Modified: 12 Aug 2025 10:51
• Thesis DOI: 10.5525/gla.thesis.85379
• URI: https://theses.gla.ac.uk/id/eprint/85379

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