DeWilde S, Carey I M, Richards N, Whincup P H, Cook D G
Division of Community Health Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
Heart. 2008 Jan;94(1):83-8. doi: 10.1136/hrt.2006.111757. Epub 2007 May 31.
Statins, antiplatelet drugs, beta-blockers and ACE inhibitors may produce marked benefits in secondary prevention of ischaemic heart disease (IHD), especially in combination.
To examine trends in treatment and factors associated with treatment using a population-based general practice database.
Analysis of routinely collected computerised data from 201 general practices using iSOFT software contributing to the DIN-LINK database.
Subjects aged >or=35 years and registered with the practices; on average, 30 000 men and 21 000 women with IHD each year.
Percentage of subjects with IHD receiving individual drugs and combined treatment in any given year.
Between 1994 and 2005 use of drugs for secondary prevention increased markedly. By 2005, 80% of men and 70% of women were receiving a statin, 75% and 74% were receiving antiplatelet drugs, 55% and 48% were receiving beta-blockers and 57% and 51% were receiving an ACE inhibitor; 55% of men and 46% of women were receiving a statin, antiplatelet drug and either beta-blocker or ACE inhibitor, of whom just under half were receiving all four classes of drug. Gender differences were largely explained by more severe disease in men. In 2005, subjects less likely to receive combination therapy were older, had not had a myocardial infarction or revascularisation, and lacked comorbidities such as diabetes or hypertension.
Despite high levels of statin and antiplatelet prescribing, opportunities exist for increasing the benefits of secondary prevention, especially through the wider use of combined treatments. Future targets could usefully include combination therapy.
他汀类药物、抗血小板药物、β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂在缺血性心脏病（IHD）二级预防中可能产生显著益处，尤其是联合使用时。
利用基于人群的全科医疗数据库研究治疗趋势及与治疗相关的因素。
使用iSOFT软件对来自201家全科诊所常规收集的计算机化数据进行分析，这些数据纳入了DIN-LINK数据库。
年龄≥35岁且在这些诊所注册的患者；每年平均有30000名男性和21000名女性患有IHD。
在任何给定年份中，患有IHD的患者接受单一药物治疗和联合治疗的百分比。
1994年至2005年间，用于二级预防的药物使用显著增加。到2005年，80%的男性和70%的女性接受他汀类药物治疗，75%的男性和74%的女性接受抗血小板药物治疗，55%的男性和48%的女性接受β受体阻滞剂治疗，57%的男性和51%的女性接受ACE抑制剂治疗；55%的男性和46%的女性接受他汀类药物、抗血小板药物以及β受体阻滞剂或ACE抑制剂治疗，其中不到一半的人接受了所有四类药物治疗。性别差异在很大程度上是由男性病情更严重所致。2005年，不太可能接受联合治疗的患者年龄较大，未发生过心肌梗死或血管重建，且没有糖尿病或高血压等合并症。
尽管他汀类药物和抗血小板药物的处方率较高，但仍有机会增加二级预防的益处，特别是通过更广泛地使用联合治疗。未来的目标可有效地包括联合治疗。
