Konduracka Ewa, Jóźwiak Jacek, Mastej Mirosław, Lukas Witold, Tykarski Andrzej, Szczepaniak-Chicheł Ludwina, Piwowarska Wiesława
Dept. of Coronary Disease, Jagiellonian University School of Medicine, Krakow, Poland.
Przegl Lek. 2008;65(12):834-7.
Despite major advances in cardiology dyslipidemia continues to be underdiagnosed and undertreated. The study aimed to evaluate current prevalence of dyslipidemia and treatment efficacy in both coronary and non-coronary subjects.
17,065 subjects aged 30-95 years (20.51%--coronary heart disease (CHD) patients), seeking medical help for disparate reasons from 675 family physicians, were randomly enrolled. Family physicians completed pertinent questionnaires against available medical records and measured patients' lipid levels during a single appointment.
Dyslipidemia was detected in 73% of the CHD subjects vs. 46% of the non-CHD ones (p = 0.00001); its severity differing regionally. Hypolipemic treatment was administered to 82% of the CHD subjects vs. 12% of the non-CHD ones (p = 0.00001). Mean concentrations of LDL-cholesterol were higher in the treated subjects (p = 0.00002). Only 10% of the CHD subjects and 20% of the non-CHD ones were treated effectively for dyslipidemiae.
Dyslipidemia was found widely prevalent nationwide, as well as poorly pharmacologically controlled in both primary and secondary prevention. Diversity of economic factors notwithstanding, this was mainly attributable to ineffective patient educational policies, meriting therefore immediate expansion and enhancement of existing disease management system in terms of adequate monitoring and effective treatment of key coronary risk factors.
尽管心脏病学取得了重大进展,但血脂异常仍然诊断不足且治疗不充分。本研究旨在评估冠心病和非冠心病患者中血脂异常的当前患病率及治疗效果。
随机招募了17065名年龄在30 - 95岁之间的受试者(20.51%为冠心病患者),他们因不同原因向675名家庭医生寻求医疗帮助。家庭医生根据现有病历填写相关问卷,并在一次就诊时测量患者的血脂水平。
冠心病患者中73%检测出血脂异常,而非冠心病患者中这一比例为46%(p = 0.00001);其严重程度存在地区差异。82%的冠心病患者接受了降血脂治疗,而非冠心病患者中这一比例为12%(p = 0.00001)。接受治疗的患者中低密度脂蛋白胆固醇的平均浓度更高(p = 0.00002)。只有10%的冠心病患者和20%的非冠心病患者血脂异常得到有效治疗。
血脂异常在全国范围内广泛流行,在一级和二级预防中药物控制效果均较差。尽管存在多种经济因素,但这主要归因于患者教育政策无效,因此有必要立即扩大和加强现有疾病管理系统,对关键的冠心病危险因素进行充分监测和有效治疗。