Nakamura Jo, Amano Wataru, Araki You, Ishii Kazuchika, Uchida Yoshihiro, Kon Toshio, Sato Yasuo, Shiozaki Masahide, Takada Kazuko, Naito Hirokuni, Nagaiwa Jiro, Nakajima Kiyotaka, Yoshida Katsuya, Watanabe Yutaka, Tomaru Takanobu, Aoyagi Teruhiko
Department of Cardiovascular Medicine, Sakura Hospital, Faculty of Medicine, Toho University, Chiba.
J Cardiol. 2003 Nov;42(5):207-12.
Many large-scale clinical trials have confirmed that coronary risk factors such as hypertension, hyperlipidemia and diabetes mellitus predict a higher incidence of cardiovascular events and that control of these risk factors reduces the incidence. However, the actual management of such risk factors and the resultant improvement of the cardiovascular events in primary practice remains unclear. The Heart Care Network Shibuya, a voluntary study group of regional primary physicians, surveyed the management of coronary risk factors and the clinical outcomes.
Behavioral patterns of the coronary risk factor was investigated in the management and resultant changes of the risk factors in 209 outpatients (mean age 65.6 +/- 11.2 years) with more than one of hypertension, hyperlipidemia, diabetes mellitus or prior myocardial infarction for 1 year.
Prescriptions of anti-hypertensive (from 1.3 +/- 0.8 to 1.4 +/- 0.8 drugs per patient) and antihyperlipidemia drugs (from 0.70 +/- 0.4 to 0.73 +/- 0.4 drugs per patient) did not significantly increase. Patient education for diet (93% to 97%, p = 0.077), exercise (69% to 81%, p < 0.05) and nonsmoking (66% to 86%, p < 0.05) significantly increased after 1 year. Blood pressure decreased from 142 +/- 16/81 +/- 10 to 138 +/- 78/78 +/- 9 mmHg (p < 0.05), serum total cholesterol level decreased from 215 +/- 39 to 203 +/- 39 mg/dl (p < 0.05). As a result, more patients attained the treatment goals recommended in the guidelines by the Japanese Society of Hypertension (34.6% to 46.8%) and Japan Atherosclerosis Society (40.2% to 49.5%), respectively. However, none of blood hemoglobin A1c level, body mass index or smokers significantly changed.
Regional practitioners attempted to control all coronary risk factors. Hypertension and hyperlipidemia, which are relatively more dependent on the medical management, improved. In contrast, diabetes mellitus, obesity or smoking, which require life style changes, did not improve. The main issue in the risk factor management is how physicians act rather than specific actions.
许多大规模临床试验已证实，高血压、高脂血症和糖尿病等冠心病危险因素预示着心血管事件的发生率较高，而控制这些危险因素可降低其发生率。然而，在基层医疗实践中，这些危险因素的实际管理情况以及由此带来的心血管事件改善情况仍不明确。涩谷心脏保健网络是一个由地区基层医生组成的自愿研究小组，对冠心病危险因素的管理及临床结果进行了调查。
对209例患有高血压、高脂血症、糖尿病或既往心肌梗死中一种以上疾病的门诊患者（平均年龄65.6±11.2岁）进行了为期1年的冠心病危险因素行为模式调查，并观察了危险因素的管理及相应变化。
抗高血压药物（每位患者从1.3±0.8种增加至1.4±0.8种）和抗高脂血症药物（每位患者从0.70±0.4种增加至0.73±0.4种）的处方量没有显著增加。1年后，饮食方面的患者教育（从93%增至97%，p = 0.077）、运动方面（从69%增至81%，p < 0.05）和戒烟方面（从66%增至86%，p < 0.05）显著增加。血压从142±16/81±10降至138±7/78±9 mmHg（p < 0.05），血清总胆固醇水平从215±39降至203±39 mg/dl（p < 0.05）。结果，分别有更多患者达到了日本高血压学会（从34.6%增至46.8%）和日本动脉粥样硬化学会（从40.2%增至49.5%）指南中推荐的治疗目标。然而，糖化血红蛋白水平、体重指数或吸烟者均无显著变化。
地区医生试图控制所有冠心病危险因素。相对更依赖药物治疗的高血压和高脂血症有所改善。相比之下，需要改变生活方式的糖尿病、肥胖或吸烟情况并未改善。危险因素管理中的主要问题在于医生如何行动，而非具体的行动措施。
