Röther Joachim, Alberts Mark J, Touzé Emmanuel, Mas Jean-Louis, Hill Michael D, Michel Patrik, Bhatt Deepak L, Aichner Franz T, Goto Shinya, Matsumoto Masayasu, Ohman E Magnus, Okada Yasushi, Uchiyama Shinichiro, D'Agostino Ralph, Hirsch Alan T, Wilson Peter W F, Steg P Gabriel
Department of Neurology, Klinikum Minden, Hannover Medical School, Minden, Germany.
Cerebrovasc Dis. 2008;25(4):366-74. doi: 10.1159/000120687. Epub 2008 Mar 13.
Cerebrovascular disease (CVD) is a global public health problem. CVD patients are at high risk of recurrent stroke and other atherothrombotic events. Prevalence of risk factors, comorbidities, utilization of secondary prevention therapies and adherence to guidelines all influence the recurrent event rate. We assessed these factors in 18,992 CVD patients within a worldwide registry of stable outpatients.
The Reduction of Atherothrombosis for Continued Health Registry recruited >68,000 outpatients (44 countries). The subjects were mainly recruited by general practitioners (44%) and internists (29%) if they had symptomatic CVD, coronary artery disease, peripheral arterial disease (PAD) and/or >or=3 atherothrombotic risk factors.
The 18,992 CVD patients suffered a stroke (53.7%), transient ischemic attack (TIA) (27.7%) or both (18.5%); 40% had symptomatic atherothrombotic disease in >or=1 additional vascular beds: 36% coronary artery disease; 10% PAD and 6% both. The prevalence of risk factors at baseline was higher in the TIA subgroup than in the stroke group: treated hypertension (83.5/82.0%; p = 0.02), body mass index >or=30 (26.7/20.8%; p < 0.0001), hypercholesterolemia (65.1/52.1%; p < 0.0001), atrial fibrillation (14.7/11.9%; p < 0.0001) and carotid artery disease (42.3/29.7%; p < 0.0001). CVD patients received antiplatelet agents (81.7%), oral anticoagulants (17.3%), lipid-lowering agents (61.2%) and antihypertensives (87.9%), but guideline treatment targets were frequently not achieved (54.5% had elevated blood pressure at baseline, while 4.5% had untreated diabetes).
A high percentage of CVD patients have additional atherothrombotic disease manifestations. The risk profile puts CVD patients, especially the TIA subgroup, at high risk for future atherothrombotic events. Undertreatment is common worldwide and adherence to guidelines needs to be enforced.
脑血管疾病（CVD）是一个全球性的公共卫生问题。CVD患者发生复发性中风和其他动脉粥样硬化血栓形成事件的风险很高。危险因素的流行率、合并症、二级预防治疗的使用情况以及对指南的依从性都会影响复发事件率。我们在一个全球稳定门诊患者登记处对18992例CVD患者的这些因素进行了评估。
持续健康登记处的动脉粥样硬化血栓形成减少登记纳入了超过68000例门诊患者（44个国家）。如果患者有症状性CVD、冠状动脉疾病、外周动脉疾病（PAD）和/或≥3个动脉粥样硬化血栓形成危险因素，则主要由全科医生（44%）和内科医生（29%）招募。
18992例CVD患者发生中风（53.7%）、短暂性脑缺血发作（TIA）（27.7%）或两者皆有（18.5%）；40%在≥1个其他血管床有症状性动脉粥样硬化血栓形成疾病：36%为冠状动脉疾病；10%为PAD，6%两者皆有。TIA亚组基线时危险因素的流行率高于中风组：治疗的高血压（83.5/82.0%；p = 0.02）、体重指数≥30（26.7/20.8%；p < 0.0001）、高胆固醇血症（65.1/52.1%；p < 0.0001）、心房颤动（14.7/11.9%；p < 0.0001）和颈动脉疾病（42.3/29.7%；p < 0.0001）。CVD患者接受抗血小板药物治疗（81.7%）、口服抗凝剂治疗（17.3%）、降脂药物治疗（61.2%）和抗高血压药物治疗（87.9%），但经常未达到指南治疗目标（54.5%患者基线血压升高，而4.5%患者糖尿病未治疗）。
高比例的CVD患者有额外的动脉粥样硬化血栓形成疾病表现。这种风险状况使CVD患者，尤其是TIA亚组，面临未来动脉粥样硬化血栓形成事件的高风险。全球治疗不足很常见，需要加强对指南的依从性。
