Margeta C, Giurgea A, Hammer A, Schlager O, Zehetmayer S, Koppensteiner R, Willfort-Ehringer A
Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Int Angiol. 2009 Jun;28(3):175-80.
Recent data on the management of cardiovascular risk factors in high risk patients showed that dyslipidemia is still treated in an inadequate way, especially in diabetic patients. We wanted to analyze the impact of the recommendation of the Inter-Society Consensus for the management of PAD (TASC-II) on the actual situation.
In this retrospective cohort study we analyzed total-, HDL-, LDL-cholesterol, triglycerides and blood glucose using capillary blood in diabetic patients, admitted to our outpatient department. Besides the recording of a complete medical history and vascular risk factors, an ABI-measurement and a carotid Duplex ultrasonography were performed at presentation.
We studied 111 diabetic patients (44 female and 67 male) with a mean age (+/-SD) of 70, 3 (+/-9, 9) years; a BMI of 28, 2 (+/-4, 2) and a mean waist circumference of 103 (+/-12, 2) cm. Metabolic syndrome according to the NCEP-ATP-III criteria (2001) was shown in 86% (N.=95). 41% (N.=45) had clinically manifest vascular disease in a second and 23% (N.=26) even in a third vascular territory. Total-cholesterol was 183+/-43 mg/dL; LDL-C 94 +/-30 mg/dL; HDL-cholesterol 44 +/-12 mg/dl and triglycerides 219+/-103 mg/dL. A total of 33% (N.=37) in this high risk cohort attained the LDL-C target levels according to the TASC-II guidelines. A total of 68% (N.=76) was on a HMG-CoA-reductase-inhibitor, 61% (N.=68) had platelet aggregation inhibitors.
We found poor adherence to international guidelines for secondary prevention in diabetic patients with PAD in this outpatient setting.
近期关于高危患者心血管危险因素管理的数据显示，血脂异常的治疗方式仍不充分，尤其是在糖尿病患者中。我们希望分析血管疾病跨学会共识（TASC-II）推荐对实际情况的影响。
在这项回顾性队列研究中，我们使用毛细血管血分析了我院门诊收治的糖尿病患者的总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯和血糖。除了记录完整的病史和血管危险因素外，就诊时还进行了踝臂指数测量和颈动脉双功超声检查。
我们研究了111例糖尿病患者（44例女性和67例男性），平均年龄（±标准差）为70.3（±9.9）岁；体重指数为28.2（±4.2），平均腰围为103（±12.2）厘米。根据2001年美国国家胆固醇教育计划成人治疗组第三次报告（NCEP-ATP-III）标准，86%（n = 95）的患者患有代谢综合征。41%（n = 45）的患者在第二个血管区域有临床明显的血管疾病，23%（n = 26）的患者甚至在第三个血管区域有血管疾病。总胆固醇为183±43毫克/分升；低密度脂蛋白胆固醇94±30毫克/分升；高密度脂蛋白胆固醇44±12毫克/分升，甘油三酯219±103毫克/分升。在这个高危队列中，共有33%（n = 37）的患者达到了TASC-II指南规定的低密度脂蛋白胆固醇目标水平。共有68%（n = 76）的患者使用了HMG-CoA还原酶抑制剂，61%（n = 68）的患者使用了血小板聚集抑制剂。
我们发现在这种门诊环境下，患有外周动脉疾病的糖尿病患者对二级预防国际指南的依从性较差。
