高 CVD 风险持续性吸烟者预防心脏病学计划的有效性：EUROACTION PLUS 伐仑克林试验。
Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial.
机构信息
Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK.
出版信息
Eur Heart J. 2014 Jun 1;35(21):1411-20. doi: 10.1093/eurheartj/ehu051. Epub 2014 Mar 9.
AIM
The EUROACTION PLUS trial measured the effectiveness of a nurse-led preventive cardiology programme (EUROACTION) offering intensive smoking cessation PLUS optional varenicline for persistent high CVD risk smokers to reduce overall cardiovascular risk compared with usual care (UC) in general practice (GP).
METHODS AND RESULTS
A parallel group randomized controlled trial in 20 GP in Italy, Netherlands, Spain, and UK. Six hundred and ninety-six current smokers, (137 vascular disease and 559 high total CVD risk), were randomized 350 to EUROACTION PLUS (EA+) and 346 to UC. Specially, trained nurses offered the EUROACTION preventive cardiology programme addressing smoking cessation, diet, physical activity, and risk factor management to reduce overall cardiovascular risk. The primary endpoint was 7 day point prevalence of self-reported abstinence (validated breath carbon monoxide <10 p.p.m.) at 16 weeks. Secondary outcomes included dietary habits, physical activity, weight, blood pressure (BP), lipid, and glucose management. One hundred and seventy-seven (51%) EA+ patients (91% opted to use varenicline) were abstinent vs. 63 (19%) in UC; OR 4.52 (95% CI: 3.20-6.39). The Mediterranean diet score of ≥9 in 149 (52%) EA+ patients vs. 97 (37%) in UC; OR 1.84 (95% CI: 1.31-2.59). Physical activity target achieved in 46 (16%) EA+ patients vs. 19 (7%) in UC; OR 2.48 (95% CI: 1.41-4.36). Target BP (<140/90 mm Hg) achieved in 150 (52%) EA+ patients vs. 112 (43%) in UC, OR 1.47 (95% CI: 1.05-2.06) with no difference in antihypertensive drugs. There were no differences in management of cholesterol or glucose.
CONCLUSIONS
The EUROACTION preventive cardiology programme in high CVD risk smokers using optional varenicline substantially increased smoking abstinence over 16 weeks and also reduced overall cardiovascular risk compared with UC. REC reference: 09/H0402/85; EudraCT number: 2009-012451-18; http://www.controlled-trials.com/ISRCTN22073647, 12 February 2014, date last accessed.
目的
EUROACTION PLUS 试验旨在测量由护士主导的预防心脏病学计划（EUROACTION）的有效性，该计划为持续存在高心血管疾病风险且吸烟的患者提供强化戒烟服务，同时提供可选的伐伦克林，以降低整体心血管风险，与普通医疗保健（UC）相比，这一计划在普通医疗实践（GP）中实施。
方法和结果
这是一项在意大利、荷兰、西班牙和英国的 20 家 GP 中进行的平行组随机对照试验。696 名当前吸烟者（137 名患有血管疾病，559 名患有高总体心血管疾病风险）被随机分为 350 名接受 EUROACTION PLUS（EA+）治疗组和 346 名接受 UC 治疗组。经过专门培训的护士提供 EUROACTION 预防心脏病学计划，该计划旨在解决戒烟、饮食、体育活动和危险因素管理问题，以降低整体心血管风险。主要终点是在 16 周时，通过自我报告的 7 天点患病率（经验证的呼气一氧化碳<10 ppm）来衡量的戒烟情况。次要结局包括饮食习惯、体育活动、体重、血压（BP）、血脂和血糖管理。177 名（51%）EA+患者（91%选择使用伐伦克林）戒烟成功，而 UC 组中只有 63 名（19%）；比值比（OR）为 4.52（95%置信区间：3.20-6.39）。149 名（52%）EA+患者的地中海饮食评分≥9，而 UC 组中只有 97 名（37%）；比值比（OR）为 1.84（95%置信区间：1.31-2.59）。46 名（16%）EA+患者达到了体育活动目标，而 UC 组中只有 19 名（7%）；比值比（OR）为 2.48（95%置信区间：1.41-4.36）。150 名（52%）EA+患者达到了目标血压（<140/90mmHg），而 UC 组中只有 112 名（43%）；比值比（OR）为 1.47（95%置信区间：1.05-2.06），降压药物使用无差异。胆固醇或血糖管理无差异。
结论
在高心血管疾病风险的吸烟者中使用可选的伐伦克林进行 EUROACTION 预防心脏病学计划，与 UC 相比，在 16 周内显著增加了戒烟率，同时降低了整体心血管风险。参考注册号：09/H0402/85；EudraCT 编号：2009-012451-18；http://www.controlled-trials.com/ISRCTN22073647，2014 年 2 月 12 日，最后访问日期。
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