Hasimu Buaijiaer, Li Jue, Yu Jinming, Ma Yitong, Zhao Mingzhong, Nakayama Tomohiro, Ma Wenlin, Yang Jingang, Zheng Liqiang, Li Xiankai, Luo Yingyi, Xu Yuanxi, Zhang Lihua, Zou Lilin, Xiao Weilin, Han Yalei, Hu Dayi
Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, and Heart Center, Beijing Tongren Hospital, China.
Circ J. 2007 Jan;71(1):95-9. doi: 10.1253/circj.71.95.
Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis and is associated with elevated cardiovascular morbidity and mortality. The aim of the present study was to evaluate the use of antiplatelet agents, statins and angiotensin-converting enzyme inhibitors (ACEI) in Chinese high-risk cardiovascular (CV) patients with PAD, with an emphasis on the need for aggressive medical management of all atherosclerotic manifestations.
Medical records from 5,263 Chinese patients at high risk of CV were evaluated for the use of antiplatelet agents, statins and ACEI in patients with and without PAD. PAD was defined as an ankle-brachial index (ABI)<0.9 in either leg. Multivariable logistic regression analyses were performed to compare medication use in the 2 groups. A total of 5,254 patients were analyzed (52.9% male, mean age 67.3 years). The prevalence of PAD in the total patient group was 25.4%; 22.5% of them had PAD only. Overall, 5.7% had PAD only, 19.6% had PAD and coronary heart disease (CHD) or stroke or diabetes, 7.7% had CHD only, 12.6% had stroke only, and 13.6% had diabetes only. The 28.9% subjects having none of PAD, CHD, stroke or diabetes were used as the reference group. Only 65%, 37% and 47% of all patients received antiplatelet agents, statins and ACEI, respectively. Antiplatelets, statins, ACEI and all 3 medications were used less frequently in PAD only patients (58.1%, 35.9, 53.5% and 21.6%) vs CHD only (90.9%, 74.5%, 70.6% and 55.9%, p<0.001). All 3 proven efficacious therapies were prescribed for only 56% of patients with CHD only, 8% with stroke only, 13% with diabetes only and 21% with PAD only.
PAD is prevalent in Chinese high-risk CV patients, equivalent to CHD, but these patients receive less intensive treatment than those with CHD. Programs to improve CV risk reduction in these high-risk patients are needed.
外周动脉疾病（PAD）是全身动脉粥样硬化的重要表现，与心血管疾病发病率和死亡率升高相关。本研究旨在评估抗血小板药物、他汀类药物和血管紧张素转换酶抑制剂（ACEI）在中国高危心血管（CV）合并PAD患者中的使用情况，重点关注积极药物治疗所有动脉粥样硬化表现的必要性。
对5263例中国高危CV患者的病历进行评估，以了解有无PAD患者使用抗血小板药物、他汀类药物和ACEI的情况。PAD定义为任一腿部的踝臂指数（ABI）<0.9。进行多变量逻辑回归分析以比较两组的用药情况。共分析了5254例患者（男性占52.9%，平均年龄67.3岁）。总体患者组中PAD的患病率为25.4%；其中仅22.5%患有PAD。总体而言，5.7%仅患有PAD，19.6%患有PAD合并冠心病（CHD）或中风或糖尿病，7.7%仅患有CHD，12.6%仅患有中风，13.6%仅患有糖尿病。将28.9%无PAD、CHD、中风或糖尿病的受试者作为参照组。所有患者中分别仅有65%、37%和47%接受了抗血小板药物、他汀类药物和ACEI治疗。仅患有PAD的患者与仅患有CHD的患者相比，抗血小板药物、他汀类药物、ACEI及三种药物联合使用的频率更低（分别为58.1%、35.9%、53.5%和21.6% vs 90.9%、74.5%、70.6%和55.9%，p<0.001）。仅患有CHD的患者中，三种已证实有效的治疗方法仅应用于56%的患者，仅患有中风的患者为8%，仅患有糖尿病的患者为13%，仅患有PAD的患者为21%。
PAD在中国高危CV患者中普遍存在，与CHD相当，但这些患者接受的治疗强度低于CHD患者。需要开展相关项目以改善这些高危患者的心血管疾病风险降低情况。
