Al-Omran Mohammed, Verma Subodh, Lindsay Thomas F
Toronto General Hospital, University of Toronto, Toronto, Canada.
Ann Saudi Med. 2011 Jul-Aug;31(4):371-5. doi: 10.4103/0256-4947.83219.
Current evidence suggests that modification of atherosclerosis risk factors plays an important role in reducing adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). This study was undertaken to determine whether patients in this high-risk group were adequately using risk factor modification therapy.
Prospective study of consecutive patients with PAD from a teaching hospital.
The collected data included information about atherosclerotic risk factors and utilization of risk factor modification therapy
The 391 patients had a mean (standard deviation of 3 (1) atherosclerotic risk factors. Hypertension was identified in 56.8% of patients (222/391), of whom only 37.4% (83/222) had adequate blood pressure control (BP <140/90 mm Hg). The prevalence of diabetes mellitus (DM) was 35 % (137/391). Among patients with DM, only 49% (67/137) had adequate blood glucose control (glycosylated hemoglobin, HbA1c <7%). Statins were currently prescribed in 61% of patients (238/391), 38.7% (92/238) of whom continued to have low-density lipoprotein (LDL) >2.5 mmol/L, compared to a rate of 76.5% (117/153) among non-statin users (P<.001). The majority of patients of patients ( 72.4%; 283/391) were overweight/obese. Many patients (67.3%; 263/391) were nonsmokers; however, most (73.4%; 193/263) had a history of smoking. Antiplatelets were prescribed for 78.3% of patients (306/391), of whom 70.6% (216/306) were taking aspirin. Angiotensin converting enzyme (ACE) inhibitors were prescribed for 44.8% of patients (175/391). Among rampril users, only 36.8% of patients (53/144) were on an optimal dose.
Although atherosclerotic risk factors were prevalent in patients with PAD, we found that patients received sub-optimal use of risk reduction treatments. Effective strategies to encourage health professionals to use these adjunctive therapies need to be developed.
目前的证据表明，改变动脉粥样硬化危险因素在降低外周动脉疾病（PAD）患者不良心血管结局方面起着重要作用。本研究旨在确定这一高危组患者是否充分使用了危险因素改变疗法。
对一家教学医院连续的PAD患者进行前瞻性研究。
收集的数据包括有关动脉粥样硬化危险因素及危险因素改变疗法使用情况的信息。
391例患者平均有3（标准差1）种动脉粥样硬化危险因素。56.8%（222/391）的患者患有高血压，其中只有37.4%（83/222）的患者血压得到充分控制（血压<140/90 mmHg）。糖尿病（DM）患病率为35%（137/391）。在DM患者中，只有49%（67/137）的患者血糖得到充分控制（糖化血红蛋白，HbA1c<7%）。61%（238/391）的患者目前正在服用他汀类药物，其中38.7%（92/238）的患者低密度脂蛋白（LDL）仍>2.5 mmol/L，相比之下，未服用他汀类药物的患者中这一比例为76.5%（117/153）（P<0.001）。大多数患者（72.4%；283/391）超重/肥胖。许多患者（67.3%；263/391）不吸烟；然而，大多数（73.4%；193/263）有吸烟史。78.3%（306/391）的患者使用了抗血小板药物，其中70.6%（216/306）服用阿司匹林。44.8%（175/391）的患者使用了血管紧张素转换酶（ACE）抑制剂。在使用雷米普利 的患者中，只有36.8%（53/144）的患者服用的是最佳剂量。
尽管PAD患者中动脉粥样硬化危险因素普遍存在，但我们发现患者对降低风险治疗的使用未达到最佳水平。需要制定有效的策略来鼓励卫生专业人员使用这些辅助疗法。
