Farahani Pendar, Levine Mitchell
Center for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, ON, Canada.
J Eval Clin Pract. 2009 Feb;15(1):212-6. doi: 10.1111/j.1365-2753.2008.01002.x.
The primary goal in the clinical management of atherosclerotic cardiovascular (CV) disease is to reduce major CV risk factors. A single risk factor approach has been traditionally used for demonstrating effectiveness of therapeutic interventions designed to reduce CV risk in clinical trials, but a global CV risk reduction approach should be adopted when assessing effectiveness in the clinical practice setting.
To explore combined goal achievement for low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose and systolic-diastolic blood pressure, in patients with dyslipidemia on pharmacotherapy in community-based clinical practices across Canada.
In a cross-sectional study, patients filling a prescription for any antihyperlipidemia therapy in selected pharmacies in Ontario, Quebec, British Columbia and Nova Scotia were recruited. Family physicians of the participating patients were requested to provide information from the patient's medical record. Ten-year CV risk was identified for each patient according to the Framingham criteria.
High-risk patients comprised 52% of the patient population; 34% were moderate-risk and 14% were low-risk. Patients had a mean of 2.8 CV risk factors; high-risk 3.7, moderate-risk 2.3 and low-risk 1.2. LDL-C goal attainment was observed in 62%, 79% and 96% of patients in high-risk, moderate-risk and low-risk strata respectively. BP goal was achieved in high-risk patients 58%, moderate-risk 83% and low-risk 95%. Glucose levels were below the threshold in 91% of patients. Complete global CV risk reduction was achieved in only 21%, 66% and 92% of high-risk, moderate-risk and low-risk strata respectively.
This study illustrates that many patients with dyslipidemia in the Canadian population, and in particular the high-risk patients, did not meet the therapeutic targets for specific CV risk factors according to the Canadian guidelines. Overall, 54% of patients failed to achieve a state of complete global CV risk reduction.
动脉粥样硬化性心血管疾病（CV）临床管理的主要目标是降低主要心血管危险因素。传统上，在临床试验中采用单一危险因素方法来证明旨在降低心血管风险的治疗干预措施的有效性，但在临床实践环境中评估有效性时应采用整体心血管风险降低方法。
探讨加拿大社区临床实践中接受药物治疗的血脂异常患者低密度脂蛋白胆固醇（LDL-C）、空腹血糖和收缩压-舒张压的综合目标达成情况。
在一项横断面研究中，招募了在安大略省、魁北克省、不列颠哥伦比亚省和新斯科舍省选定药房开具任何抗高血脂治疗处方的患者。要求参与患者的家庭医生提供患者病历中的信息。根据弗雷明汉标准确定每位患者的10年心血管风险。
高危患者占患者总数的52%；34%为中危患者，14%为低危患者。患者平均有2.8个心血管危险因素；高危患者为3.7个，中危患者为2.3个，低危患者为1.2个。高危、中危和低危分层患者的LDL-C目标达成率分别为62%、79%和96%。高危患者的血压目标达成率为58%，中危患者为83%，低危患者为95%。91%的患者血糖水平低于阈值。高危、中危和低危分层患者分别仅有21%、66%和92%实现了完全的整体心血管风险降低。
本研究表明，加拿大人群中许多血脂异常患者，尤其是高危患者，未达到加拿大指南规定的特定心血管危险因素治疗目标。总体而言，54%的患者未能实现完全的整体心血管风险降低状态。
