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合并症使心血管疾病治疗复杂化:糖尿病是个例外吗?

Comorbidity complicates cardiovascular treatment: is diabetes the exception?

作者信息

Nouwens E, van Lieshout J, Wensing M

机构信息

Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101/Geert Grooteplein 21, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands.

出版信息

Neth J Med. 2012 Sep;70(7):298-305.

Abstract

BACKGROUND

Many patients with cardiovascular disease do not attain the targets for health-related lifestyle and preventive treatment recommended in practice guidelines. The aim of this study was to assess the impact of diabetes (DM) and chronic obstructive pulmonary disease (COPD) on the quality of cardiovascular risk management in patients with established cardiovascular diseases (CVD).

METHODS AND RESULTS

Patients with established CVD were randomly selected in primary care practices using recorded diagnoses. Structured case forms were used to review data on 20 performance indicators concerning CVD from medical records. Descriptive and multilevel regression analyses were conducted. In 45 primary care practices with 106 physicians in the Netherlands, 1614 medical records of patients with CVD (37.9% women) were reviewed. A total of 1076 (66.7%) patients had recorded CVD only (reference group); 7.8% had CVD and COPD; 22.4% had CVD and DM; 3.1% patients had CVD, COPD and DM. Compared with the reference group, patients with CVD and DM yielded higher scores on 17 of 20 indicators; patients with CVD, DM and COPD on 14 indicators; and patients with CVD and COPD on three indicators. Of the patients with CVD and DM, fewer patients had LDL-cholesterol levels over 2.5 mmol/l (OR=0.36; 95% CI 0.26-0.50), more had antiplatelet drugs prescribed (OR=1.72; 95% CI 1.17-2.54), and more had systolic blood pressure measurement (OR=4.12; 95% CI 2.80-6.06).

CONCLUSIONS

This study showed that DM but not COPD was associated with more comprehensive cardiovascular risk management. This finding adds to cumulating evidence that presence of DM is associated with better preventive treatment of cardiovascular risk.

摘要

背景

许多心血管疾病患者未达到实践指南中推荐的健康相关生活方式及预防性治疗目标。本研究旨在评估糖尿病(DM)和慢性阻塞性肺疾病(COPD)对已确诊心血管疾病(CVD)患者心血管风险管理质量的影响。

方法与结果

在基层医疗实践中利用记录的诊断随机选取已确诊CVD的患者。使用结构化病例表格回顾病历中有关CVD的20项绩效指标的数据。进行描述性和多水平回归分析。在荷兰45家基层医疗实践机构中,106名医生参与,共审查了1614例CVD患者的病历(女性占37.9%)。共有1076例(66.7%)患者仅记录有CVD(参照组);7.8%的患者患有CVD和COPD;22.4%的患者患有CVD和DM;3.1%的患者患有CVD、COPD和DM。与参照组相比,患有CVD和DM的患者在20项指标中的17项上得分更高;患有CVD、DM和COPD的患者在14项指标上得分更高;患有CVD和COPD的患者在3项指标上得分更高。在患有CVD和DM的患者中,低密度脂蛋白胆固醇水平超过2.5 mmol/l的患者较少(OR=0.36;95%CI 0.26 - 0.50),开具抗血小板药物的患者更多(OR=1.72;95%CI 1.17 - 2.54),进行收缩压测量的患者更多(OR=4.12;95%CI 2.80 - 6.06)。

结论

本研究表明,DM而非COPD与更全面的心血管风险管理相关。这一发现进一步累积了证据,即DM的存在与更好地预防心血管风险治疗相关。

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