Vaccaro O, Boemi M, Cavalot F, De Feo P, Miccoli R, Patti L, Rivellese A A, Trovati M, Ardigò D, Zavaroni I
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
Atherosclerosis. 2008 Jun;198(2):396-402. doi: 10.1016/j.atherosclerosis.2007.10.026. Epub 2008 Feb 21.
Guidelines for cardiovascular prevention in diabetes have been issued by the national and international scientific societies. No audit as ever been performed to evaluate the implementation of these documents in clinical practice in Italy. The study evaluates the prevalence, treatment, and control of major cardiovascular risk factors in type 2 diabetic patients, to assess the clinical practice of primary cardiovascular prevention in type 2 diabetes.
Two thousand four hundred and sixty-five men and women with type 2 diabetes, aged 50-75 and free of cardiovascular events were recruited on a consecutive basis at 10 hospital based outpatients diabetes clinics. Clinical variables were measured by standard protocol. Biochemical parameters were evaluated at each centre. The laboratories were monitored by an external quality control assessment in order to reach and maintain a standard of quality and traceability among the participating centres.
A minority of patients (5%) met the recommended targets for LDL cholesterol, blood pressure, glycated haemoglobin and smoking habits, whereas the vast majority (66%) had unsatisfactory control of three or more of the above. Achievement of desirable control of risk factors differed according to gender and known diabetes duration. Lipid lowering and, to a lesser extent, antihypertensive medications were under-used and their titration insufficiently target-driven. Prophylactic use of antiplatelet agents was scarce, only one out of five patients was treated independent of absolute cardiovascular risk.
In clinical practice there is poor adherence to national and international guidelines for primary cardiovascular prevention in type 2 diabetes in Italy. The study underlines the great potential for prevention, particularly in women and in high-risk patients.
国家和国际科学协会已发布糖尿病心血管预防指南。意大利从未进行过审计以评估这些文件在临床实践中的实施情况。本研究评估2型糖尿病患者主要心血管危险因素的患病率、治疗情况及控制情况，以评估2型糖尿病一级心血管预防的临床实践。
在10家医院的门诊糖尿病诊所连续招募了2465名年龄在50 - 75岁、无心血管事件的2型糖尿病男性和女性。通过标准方案测量临床变量。在每个中心评估生化参数。通过外部质量控制评估对实验室进行监测，以在参与中心之间达到并维持质量和可追溯性标准。
少数患者（5%）达到了低密度脂蛋白胆固醇、血压、糖化血红蛋白和吸烟习惯的推荐目标，而绝大多数（66%）对上述三项或更多项控制不佳。危险因素的理想控制情况因性别和已知糖尿病病程而异。降脂药物以及在较小程度上的降压药物使用不足，其滴定缺乏足够的目标导向。抗血小板药物的预防性使用很少，五分之一的患者仅根据绝对心血管风险接受治疗。
在意大利的临床实践中，对2型糖尿病一级心血管预防的国家和国际指南的依从性较差。该研究强调了预防的巨大潜力，特别是在女性和高危患者中。
