van Weel Chris, Bakx Carel, van den Hoogen Henk, Thien Theo, van den Bosch Wil
Department of Family Medicine, University Medical Centre Nijmegen, 229-HAG, PO Bpx 9101, 6500 HB Nijmegen, The Netherlands.
J Am Board Fam Med. 2006 Jan-Feb;19(1):62-8. doi: 10.3122/jabfm.19.1.62.
Cardiovascular disease is common and preventable. Primary care is the preferred setting for individual prevention and management.
This study analyzed the long-term outcome of cardiovascular risk in a family practice population.
A longitudinal cohort analysis of cardiovascular outcome after 18 years, in participants of a randomized controlled trial (RCT) of cardiovascular prevention. In 1977, a RCT with cluster randomization at practice level assessed the effects of a 1-year preventive intervention in patients 20 to 50 years of age. Cardiovascular risk factors (smoking, body mass index, blood pressure, serum cholesterol, family history, and physical activity) were measured and intervention was a practice-nurse support for the follow-up of those at elevated risk. The control practices prescribed care as usual. Between 1994 and 1995, all participants were approached again, to analyze subsequent (cardiovascular) mortality and morbidity and their cardiovascular risk in a random sample.
The Nijmegen Academic Family Practices Network, The Netherlands.
All participants (7092) of the 1977 screening for follow-up morbidity and mortality, 2600 for re-measurement risk factors.
Cardiovascular risk factors; cardiovascular morbidity and mortality 1977-1995.
Follow-up was achieved in 5945 participants (84%) and 2335 participated in the re-measurement (89%). No effects of the preventive intervention were found, but those initially at low risk profile were still so 18 years later. Risk of subsequent cardiovascular mortality and morbidity was related to baseline risk, but for women, the absolute risk was low in all risk strata and lower than predicted from international references.
This study demonstrated the feasibility of family practice network research in pursuing longitudinal research. A single cardiovascular screening resulted in reliable risk assessment: those initially at low risk still were so after 18 years. Effects of a 1-year intensive intervention could no longer be demonstrated.
心血管疾病很常见且可预防。初级保健是个体预防和管理的首选环境。
本研究分析了家庭医疗人群中心血管风险的长期结果。
对一项心血管预防随机对照试验（RCT）的参与者进行18年后心血管结局的纵向队列分析。1977年，一项在实践层面进行整群随机化的RCT评估了对20至50岁患者进行为期1年的预防性干预的效果。测量了心血管危险因素（吸烟、体重指数、血压、血清胆固醇、家族史和身体活动），干预措施是由执业护士对高危人群进行随访支持。对照实践按常规提供护理。1994年至1995年期间，再次联系了所有参与者，以分析随机样本中随后的（心血管）死亡率和发病率及其心血管风险。
荷兰奈梅亨学术家庭医疗网络。
1977年筛查的所有参与者（7092人）用于随访发病率和死亡率，2600人用于重新测量危险因素。
心血管危险因素；1977 - 1995年心血管发病率和死亡率。
5945名参与者（84%）完成了随访，2335人参与了重新测量（89%）。未发现预防性干预有效果，但最初风险较低的人18年后仍是如此。随后心血管疾病死亡率和发病率的风险与基线风险相关，但对于女性来说，所有风险分层中的绝对风险都很低，且低于国际参考标准预测的风险。
本研究证明了家庭医疗网络研究进行纵向研究的可行性。单次心血管筛查可得出可靠的风险评估：最初风险较低的人18年后仍然如此。为期1年的强化干预效果已无法再得到证明。
