Hackam Daniel G, Leiter Lawrence A, Yan Andrew T, Yan Raymond T, Mendelsohn Aurora, Tan Mary, Zavodni Louis, Chen Richard, Tsang Jennifer L, Kundi Anjali, Lin Peter J, Fitchett David H, Langer Anatoly, Goodman Shaun G
Department of Medicine, University of Western Ontario, London, Canada.
Can J Cardiol. 2007 Dec;23(14):1124-30. doi: 10.1016/s0828-282x(07)70882-6.
Strong evidence supports the use of antithrombotic agents (antiplatelets or oral anticoagulants), statins and angiotensin-converting enzyme inhibitors in patients with atherosclerotic cardiovascular disease; beta-blockers are additionally indicated in patients with coronary artery disease.
The investigators sought to determine the extent to which guideline-recommended treatments and target goals are adopted in ambulatory patients with cardiovascular disease in Canada.
Two large, prospective, community-based registries (the Vascular Protection Registry and the Guideline Oriented Approach to Lipid Lowering Registry) enrolled 9809 outpatients with coronary artery disease, cerebrovascular disease, peripheral vascular disease or multiple cardiovascular risk factors from primary care settings in nine provinces across Canada between 2001 and 2004. This analysis focused primarily on patients with cardiovascular disease (n=6296).
At baseline, antithrombotics, statins and angiotensin-converting enzyme inhibitors were used in 92%, 80% and 57% of patients, respectively; beta-blockers were used in 59% of patients with coronary artery disease. The dosing of most drug therapies was suboptimal compared with guideline-recommended dosing derived from clinical trials. Treatment goals for cardiovascular risk factors were suboptimally attained: low-density lipoprotein cholesterol in 50% of patients, total to high-density lipoprotein cholesterol ratio in 51% of patients, systolic and diastolic blood pressure in 58% and 78% of patients, respectively, and waist circumference and body mass index in 45% and 19%, respectively.
These data suggest specific opportunities for improving the care of patients with cardiovascular disease in Canada. The focus must now shift from awareness of treatment gaps to implementation of effective solutions.
有力证据支持在动脉粥样硬化性心血管疾病患者中使用抗血栓药物（抗血小板药物或口服抗凝剂）、他汀类药物和血管紧张素转换酶抑制剂；β受体阻滞剂还适用于冠心病患者。
研究人员试图确定加拿大门诊心血管疾病患者采用指南推荐治疗方法和目标的程度。
两个大型、前瞻性、基于社区的登记处（血管保护登记处和脂质降低指南导向登记处）在2001年至2004年期间，从加拿大九个省份的初级保健机构招募了9809名患有冠心病、脑血管疾病、外周血管疾病或多种心血管危险因素的门诊患者。该分析主要集中在心血管疾病患者（n = 6296）。
在基线时，分别有92%、80%和57%的患者使用了抗血栓药物、他汀类药物和血管紧张素转换酶抑制剂；59%的冠心病患者使用了β受体阻滞剂。与来自临床试验的指南推荐剂量相比，大多数药物治疗的剂量未达到最佳。心血管危险因素的治疗目标未得到最佳实现：50%的患者低密度脂蛋白胆固醇达标，51%的患者总胆固醇与高密度脂蛋白胆固醇比值达标，58%和78%的患者收缩压和舒张压达标，45%和19%的患者腰围和体重指数达标。
这些数据表明在加拿大改善心血管疾病患者护理方面存在特定机会。现在重点必须从认识治疗差距转向实施有效解决方案。
