Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
BMJ. 2012 Jul 12;345:e4535. doi: 10.1136/bmj.e4535.
To establish the impact of age and sex on primary preventive treatment for cardiovascular disease in a typical primary care population.
Cross sectional study of anonymised patient records.
All 41,250 records of patients aged ≥ 40 registered at 19 general practices in the West Midlands, United Kingdom, were extracted and analysed.
Patients' demographics, risk factors for cardiovascular disease (blood pressure, total cholesterol concentration), and prescriptions for primary preventive drugs were extracted from patients' records. Patients were subdivided into five year age bands up to 85 (patients aged ≥ 85 were analysed as one group) and prescribing trends across the population were assessed by estimating the proportion of patients prescribed with antihypertensive drug or statin drug, or both, in each group.
Of the 41,250 records screened in this study, 36,679 (89%) patients did not have a history of cardiovascular disease and therefore could be considered for primary preventive treatment. The proportion receiving antihypertensive drugs increased with age (from 5% (378/6978) aged 40-44 to 57% (621/1092) aged ≥ 85) as did the proportion taking statins up to the age of 74 (from 3% (201/6978) aged 40-44 to 29% (675/2367) aged 70-74). In those aged 75 and above, the odds of a receiving prescription for a statin (relative to the 40-44 age group) decreased with every five year increment in age (odds ratio 12.9 (95% confidence interval 10.8 to 15.3) at age 75-79 to 5.7 (4.6 to 7.2) at age ≥ 85; P<0.001). There were no consistent differences in prescribing trends by sex.
Previously described undertreatment of women in secondary prevention of cardiovascular disease was not observed for primary prevention. Low use of statins in older people highlights the need for a stronger evidence base and clearer guidelines for people aged over 75.
在典型的初级保健人群中，确定年龄和性别对心血管疾病一级预防治疗的影响。
对匿名患者记录进行的横断面研究。
从英国西米德兰兹郡 19 家全科诊所中登记的所有 41250 名年龄≥40 岁的患者记录中提取并分析了患者的人口统计学数据、心血管疾病风险因素（血压、总胆固醇浓度）以及一级预防药物的处方。患者被分为五个五年年龄组，最高至 85 岁（≥85 岁的患者作为一组进行分析），通过估计每个年龄组接受抗高血压药物或他汀类药物或两者联合治疗的患者比例，评估人群中的处方趋势。
在本研究中筛选的 41250 份记录中，36679 名（89%）患者没有心血管疾病病史，因此可以考虑进行一级预防治疗。接受抗高血压药物治疗的比例随着年龄的增长而增加（从 40-44 岁的 5%（378/6978）增加到≥85 岁的 57%（621/1092）），接受他汀类药物治疗的比例也增加至 74 岁（从 40-44 岁的 3%（201/6978）增加到 70-74 岁的 29%（675/2367））。在 75 岁及以上的患者中，与 40-44 岁年龄组相比，接受他汀类药物处方的几率随着每五年的年龄增长而降低（75-79 岁的比值比为 12.9（95%置信区间为 10.8 至 15.3），≥85 岁的比值比为 5.7（4.6 至 7.2）；P<0.001）。按性别划分，处方趋势没有一致的差异。
在心血管疾病二级预防中，女性治疗不足的情况在一级预防中并未出现。在老年人中他汀类药物的使用率较低，这突显了需要为 75 岁以上人群提供更有力的证据基础和更明确的指南。
