Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
Ann Pharmacother. 2012 Feb;46(2):183-91. doi: 10.1345/aph.1Q572. Epub 2012 Feb 7.
There is insufficient evidence for the efficacy of comprehensive multiple risk factor interventions by pharmacists in the primary prevention of cardiovascular disease (CVD). Given the proven benefits of pharmacist interventions for individual risk factors, it is essential that evidence for a comprehensive approach to care be generated so that pharmacists remain key members of the health care team for individuals at risk of initial onset of CVD.
To establish the feasibility of an intervention delivered by community pharmacists to reduce the risk of primary onset of CVD.
A single-cohort intervention study was undertaken in 2008-2009. Twelve community pharmacists from 10 pharmacies who were trained to provide lifestyle and medicine management support to reduce CVD risk recruited 70 at-risk participants aged 50-74 years who were free from diabetes or CVD. Participants received a baseline assessment to establish CVD risk and health behaviors. An assessment report provided to patients and pharmacists was used to collaboratively establish treatment goals and, over 5 sessions, implement treatment strategies. Follow-up assessment at 6 months measured changes in baseline parameters. The primary outcome was the average change to overall 5-year risk of CVD onset.
Sixty-seven participants were included in the analysis. The mean participant age was 60 years and 73% were female. We observed a 25% (95% CI 17 to 33) proportional risk reduction in overall CVD risk. Significant reductions also occurred in mean blood pressure (-11/-5 mm Hg) and waist circumference (-1.3 cm), with trends toward improvement for most other observed risk factors.
Findings support previous evidence of positive cardiovascular health outcomes following pharmacist intervention in other patient groups; we recommend generating randomized controlled trial evidence for a primary prevention population.
药师进行综合多重危险因素干预对心血管疾病（CVD）一级预防的疗效证据不足。鉴于药师干预个别危险因素的益处已得到证实，因此必须生成综合护理方法的证据，以使药师仍然成为有初发 CVD 风险个体的医疗保健团队的关键成员。
确定社区药师实施的干预措施降低 CVD 初发风险的可行性。
2008-2009 年进行了一项单队列干预研究。10 家药店的 12 名接受过培训以提供生活方式和药物管理支持以降低 CVD 风险的社区药师招募了 70 名年龄在 50-74 岁、无糖尿病或 CVD 的高危参与者。参与者接受了基线评估以确定 CVD 风险和健康行为。向患者和药师提供评估报告，以共同确定治疗目标，并在 5 次就诊中实施治疗策略。在 6 个月时进行随访评估，以测量基线参数的变化。主要结局是 CVD 发病整体 5 年风险的平均变化。
67 名参与者纳入分析。参与者的平均年龄为 60 岁，73%为女性。我们观察到整体 CVD 风险降低了 25%（95%CI 17 至 33）。平均血压（-11/-5mmHg）和腰围（-1.3cm）也显著降低，大多数其他观察到的危险因素也有改善趋势。
这些发现支持了之前关于药师干预对其他患者群体心血管健康结果的积极影响的证据；我们建议为一级预防人群生成随机对照试验证据。
