Department of Internal Medicine, University of Banja-Luka, Banja-Luka, Bosnia and Herzegovina.
Am J Cardiovasc Drugs. 2010;10(2):109-14. doi: 10.2165/11535240-000000000-00000.
Guidelines for cardiovascular risk factor control in people with coronary heart disease (CHD) focus on compliance with beta-adrenoceptor antagonists (beta-blockers), angiotensin receptor blockade (ACE inhibitors/angiotensin II receptor antagonists [angiotensin receptor blockers; ARBs]) [ACE/ARBs], and lipid-lowering agents, with goals for BP of <140/90 mmHg and low-density lipoprotein cholesterol (LDL-C) levels of <2.6 mmol/L (100 mg/dL). Most data derive from registries of hospitalized patients or are from clinical trials. Little data exist on goal attainment and adherence with therapy among CHD survivors of major US ethnic groups in the real-world setting.
We assessed levels of cardiovascular risk factor control and adherence with recommended therapies among US CHD survivors.
We identified 364 US adults (representing 12.8 million in the US with CHD) aged 18 years and over in the National Health and Nutrition Examination Survey 2005-6 with known CHD. We calculated proportions of patients who were receiving recommended treatments, and who achieved goal targets for BP, LDL-C levels, glycosylated hemoglobin (HbA(1c)), and nonsmoking status, and differences between actual and goal levels ('distance to goal'), stratified by sex and ethnicity.
Overall, 58%, 38%, and 60% of CHD survivors were receiving beta-adrenoceptor antagonists, ACE/ARBs, and lipid-lowering medications, respectively (22% received all three). However, treatment rates for beta-adrenoceptor antagonists and lipid-lowering agents were lower (p < 0.05 to p < 0.01) in Hispanics (36% and 27%, respectively) and non-Hispanic Blacks (47% and 42%, respectively) than in non-Hispanic Whites. Moreover, lipid-lowering treatment rates were lower in females (50%) than in males (67%) [p < 0.01]. Overall, 78% were nonsmokers while 68% achieved goal levels for BP, 57% for LDL-C levels, and, if diabetic, 67% for HbA(1c). Only 12% met all four goals. Non-Hispanic Whites had the lowest SBP and DBP as well as HbA(1c) (p < 0.05 to p < 0.01 across ethnicity). In those who did not achieve goal levels, distance to goal averaged 1.0 mmol/L (37.0 mg/dL) for LDL-C levels, 15.6 mmHg for SBP, and 1.3% for HbA(1c).
Despite clear treatment guidelines, we show that many US adults with CHD, especially Hispanics and non-Hispanic Blacks, are neither receiving recommended treatments nor adequately treated in terms of BP, LDL-C levels, and HbA(1c). Greater efforts by healthcare systems to disseminate and implement guidelines are needed.
针对冠心病 (CHD) 患者心血管风险因素控制的指南侧重于遵守β-肾上腺素受体拮抗剂（β-受体阻滞剂）、血管紧张素受体阻断剂（ACE 抑制剂/血管紧张素 II 受体拮抗剂[血管紧张素受体阻滞剂；ARB]）[ACE/ARB]和降脂药物，血压目标为 <140/90 mmHg 和低密度脂蛋白胆固醇 (LDL-C) 水平 <2.6 mmol/L（100 mg/dL）。大多数数据来自住院患者的登记册或临床试验。在美国，很少有关于主要种族群体 CHD 幸存者在真实环境中实现目标和坚持治疗的数据。
我们评估了美国 CHD 幸存者的心血管风险因素控制和遵医嘱治疗的情况。
我们在 2005-2006 年全国健康和营养调查中确定了 364 名年龄在 18 岁及以上的美国成年人（代表美国有 CHD 的 1280 万人），已知患有 CHD。我们计算了接受推荐治疗的患者比例，以及达到血压、LDL-C 水平、糖化血红蛋白 (HbA(1c)) 和非吸烟状态目标的患者比例，并根据性别和种族对实际和目标水平之间的差异（“目标差距”）进行了分层。
总体而言，58%、38%和 60%的 CHD 幸存者分别接受了β-受体阻滞剂、ACE/ARB 和降脂药物治疗（22%的患者同时接受了这三种治疗）。然而，西班牙裔（分别为 36%和 27%）和非西班牙裔黑人（分别为 47%和 42%）接受β-受体阻滞剂和降脂药物治疗的比率较低（p<0.05 至 p<0.01）。此外，女性（50%）的降脂药物治疗率低于男性（67%）[p<0.01]。总体而言，78%的患者不吸烟，68%的患者血压达到目标水平，57%的患者 LDL-C 水平达到目标水平，如果患有糖尿病，则 67%的患者 HbA(1c)达到目标水平。只有 12%的人同时达到了所有四个目标。非西班牙裔白人的收缩压和舒张压以及 HbA(1c)最低（p<0.05 至 p<0.01 各种族之间）。在未达到目标水平的患者中，LDL-C 水平的目标差距平均为 1.0 mmol/L（37.0 mg/dL），收缩压为 15.6 mmHg，HbA(1c)为 1.3%。
尽管有明确的治疗指南，但我们发现许多美国 CHD 成年人，尤其是西班牙裔和非西班牙裔黑人，既没有接受推荐的治疗，也没有在血压、LDL-C 水平和 HbA(1c)方面得到充分治疗。医疗保健系统需要做出更大的努力来传播和实施指南。
