Bennett K E, Williams D, Feely J
Department of Therapeutics and Pharmacology, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
Eur J Clin Pharmacol. 2003 Apr;58(12):835-41. doi: 10.1007/s00228-002-0542-6. Epub 2003 Feb 26.
To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes.
Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy, including insulin and oral hypoglycaemic drugs, or diagnostic test kit for glucose ( n=8523) and those receiving no such therapies ( n=145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified ( n=14,826). Odds ratios and 95% confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and gender, were calculated using logistic regression.
The proportion of those (and 95% CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3% (35.0, 39.6) for statins, 55.3% (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7% (32.5, 36.9) for beta blockers, 73.3% (71.2, 75.4) for aspirin, 4.4% (3.4, 5.4) for angiotensin-II antagonists and 2.5% (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates.
The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.
确定与非糖尿病患者相比，糖尿病患者在初级保健中接受心血管治疗的比例。
利用国家初级保健处方数据库对有糖尿病和无糖尿病患者进行人群研究。确定了爱尔兰东部地区卫生局在1年期间（1999年9月至2000年8月）接受任何糖尿病治疗处方（包括胰岛素和口服降糖药）或葡萄糖诊断试剂盒的所有患者（n = 8523）以及未接受此类治疗的患者（n = 145756）。此外，还确定了接受硝酸盐处方（缺血性心脏病的一个标志物）的患者亚组（n = 14826）。使用逻辑回归计算糖尿病患者和非糖尿病患者之间心血管治疗处方的优势比和95%置信区间，并对年龄和性别进行调整。
患有糖尿病和缺血性心脏病且接受二级预防治疗的患者中，他汀类药物的处方比例为37.3%（35.0，39.6），血管紧张素转换酶抑制剂为55.3%（53.0，57.6），β受体阻滞剂为34.7%（32.5，36.9），阿司匹林为73.3%（71.2，75.4），血管紧张素II拮抗剂为4.4%（3.4，5.4），贝特类药物为2.5%（1.8，3.2）。与非糖尿病患者相比，糖尿病患者处方的调整后优势比，他汀类药物为1.44（1.30，1.61），血管紧张素转换酶抑制剂为3.09（2.79，3.42），β受体阻滞剂为0.82（0.74，0.91），阿司匹林为1.23（1.09，1.38），血管紧张素II受体阻滞剂为1.47（1.13，1.87），降脂贝特类药物为4.23（2.88，6.14）。
鉴于糖尿病患者冠心病风险较高，糖尿病患者心血管治疗的处方率高于非糖尿病患者并不意外。然而，糖尿病患者，特别是已确诊缺血性心脏病的患者，接受心血管治疗的比例远低于当地和国际指南中的推荐比例。
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