Lahoz-Rallo Blanca, Blanco-Gonzalez Manuel, Casas-Ciria Inmaculada, Marín-Andrade Jose Alberto, Mendez-Segovia Juan Carlos, Moratalla-Rodriguez Guillermo, Quintero-Dominguez Rafael, Ramirez-Raya Manuel, Guerrero-Pinedo Maria Jose, Aguilar-Diosdado Manuel
Primary Care Area of Cádiz-La Janda and Jerez, Spain.
Diabetes Res Clin Pract. 2007 Jun;76(3):436-44. doi: 10.1016/j.diabres.2006.09.028. Epub 2006 Oct 24.
To calculate overall 10-year cardiovascular disease (CVD) risk for patients with type 2 diabetes we applied the UKPDS and SCORE prediction models to data derived from clinical notes of 1846 patients (mean age 65.5 years; 55.8% women) with type 2 diabetes attending eight Primary-Care Centres serving a catchment population of 200,000 citizens in Andalusia. The results showed obesity and high blood pressure present in >50%, established CVD in 24%, retinopathy in 30%, and nephropathy in 17%. Mean HbAlc level was 7.3%. Compliance with therapeutic goals was 54% for systolic blood pressure <130 mmHg, 39% for HbA1c <7% and 9% for LDL cholesterol <2.58 mmol/L. Approximately 33% were receiving treatment with metformin, statins, renin-angiotensin system inhibitors and anti-aggregation agents. UKPDS risk for coronary heart disease (CHD) was 23% and 16% for stroke. The SCORE 10-year mortality risk was 5%. Correlation coefficient between the two models predicting CVD risk was 0.68 (p<0.001). We conclude that, despite the European consensus that CVD is low in Mediterranean countries, the CVD risk factors in the type 2 diabetes sub-population in southern Spain is relatively high. Specific measures of health-care intervention are needed if CVD-associated morbido-mortality rates in these diabetic patients are to be reduced.
为计算2型糖尿病患者的总体10年心血管疾病（CVD）风险，我们将英国前瞻性糖尿病研究（UKPDS）和系统性冠状动脉风险评估（SCORE）预测模型应用于来自安达卢西亚8个基层医疗中心的1846例2型糖尿病患者（平均年龄65.5岁；55.8%为女性）临床记录的数据，这些中心服务于20万居民的集水区人群。结果显示，超过50%的患者存在肥胖和高血压，24%的患者已患心血管疾病，30%的患者有视网膜病变，17%的患者有肾病。平均糖化血红蛋白（HbAlc）水平为7.3%。收缩压<130 mmHg的治疗目标依从率为54%，糖化血红蛋白<7%的依从率为39%，低密度脂蛋白胆固醇<2.58 mmol/L的依从率为9%。约33%的患者正在接受二甲双胍、他汀类药物、肾素 - 血管紧张素系统抑制剂和抗聚集药物治疗。UKPDS模型预测冠心病（CHD）的风险为23%，中风风险为16%。SCORE模型预测的10年死亡风险为5%。两种预测CVD风险模型之间的相关系数为0.68（p<0.001）。我们得出结论，尽管欧洲普遍认为地中海国家的心血管疾病风险较低，但西班牙南部2型糖尿病亚人群中的心血管疾病风险因素相对较高。如果要降低这些糖尿病患者的心血管疾病相关发病率和死亡率，需要采取特定的医疗保健干预措施。
