Dedola M, Godoi E, Coppé G, Cambou J P, Cantet C, Mas J L, Guérillot M, Vahanian A, Herrman M A, Jullien G, Leizorovicz A, Boccalon H
Service de médecine vasculaire, CHU Rangueil, Toulouse.
Arch Mal Coeur Vaiss. 2005 Dec;98(12):1179-86.
we examined the management of risk factors in patients suffering from obliterating peripheral arterial disease (OPAD), in urban medical practice.
PRISMA, ECLAT1 and APRES are surveys based on urban medicine in France. These 3 studies have allowed a compilation of data pertaining to the control of risk factors in patients suffering from one or more clinical manifestations of atherothrombosis, including cerebral vascular accident, coronary insufficiency or OPAD. The study population was divided among patients with isolated OPAD, versus OPAD associated with coronary artery disease (CAD), versus OPAD associated with cerebral vascular disease.
a total of 5 708 patients with stable OPAD were included among the 3 studies. Risk factors were not managed in the majority of patients, including 62.6% of hypercholesterolemic patients, 71.1% of diabetics, and 77.4% of hypertensive patients. Overall, the control of risk factors was less satisfactory in patients with OPAD than in patients with CAD. Smoking (70.6% current or past smokers) remains a major risk factor in OPAD. The proportion of current smokers was significantly higher is the group with isolated OPAD than in the other 2 groups of patients (p < 0.0001).
The control of risk factors in patients with OPAD is suboptimal, mainly because of failure to reach the therapeutic goals, rather than because of poor medical management. It is important that recent recommendations be implemented in medical practice. Awareness of the primary physicians will be key in the optimisation of treatment prescriptions and, above all, in the achievement of a higher level of clinical performance.
我们在城市医疗实践中，研究了患有闭塞性外周动脉疾病（OPAD）患者的危险因素管理情况。
PRISMA、ECLAT1和APRES是基于法国城市医学的调查。这三项研究汇总了有关患有一种或多种动脉粥样硬化血栓形成临床表现（包括脑血管意外、冠状动脉供血不足或OPAD）患者的危险因素控制数据。研究人群分为单纯OPAD患者、合并冠状动脉疾病（CAD）的OPAD患者以及合并脑血管疾病的OPAD患者。
三项研究共纳入5708例稳定型OPAD患者。大多数患者的危险因素未得到管理，包括62.6%的高胆固醇血症患者、71.1%的糖尿病患者和77.4%的高血压患者。总体而言，OPAD患者的危险因素控制不如CAD患者令人满意。吸烟（70.6%为当前或既往吸烟者）仍然是OPAD的主要危险因素。单纯OPAD组的当前吸烟者比例显著高于其他两组患者（p<0.0001）。
OPAD患者的危险因素控制不理想，主要是因为未能达到治疗目标，而非医疗管理不善。在医疗实践中实施最新建议很重要。基层医生的意识对于优化治疗处方至关重要，尤其是对于实现更高水平的临床疗效而言。
