Shah Nilay S, Huffman Mark D, Ning Hongyan, Lloyd-Jones Donald M
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.) Department of Medicine, Stanford University School of Medicine, Stanford, CA (N.S.S.).
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.S.S., M.D.H., H.N., D.M.L.J.) Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H., D.M.L.J.).
J Am Heart Assoc. 2015 Apr 22;4(4):e001709. doi: 10.1161/JAHA.114.001709.
Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse.
We evaluated sex- and race-stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 individuals who self-reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys (NHANES) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011-2012, with significant increases in control rates (as then defined) in men to 85% in 2011-2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non-Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011-2012, and aspirin use increased significantly but only to 28% by 2011-2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non-Hispanic blacks. Projected hypertension control rates remained suboptimal.
While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high-risk group.
评估缺血性心脏病二级预防中血管危险因素治疗及控制率近期趋势和未来预测的全国代表性数据较为匮乏。
我们评估了1999年至2012年美国国家健康与营养检查调查（NHANES）中1580名自述有心肌梗死病史个体的性别和种族分层的胆固醇、血压及糖化血红蛋白水平，以及危险因素治疗和控制率。我们使用加权线性回归估计时间趋势，并对2020年进行线性向前预测。参与者中女性占30%至41%，白人占73%至85%，平均年龄为63至66岁。到2011 - 2012年，胆固醇治疗率上升，男性和女性均超过80%，男性控制率（当时定义）显著上升至2011 - 2012年的85%，预计到2020年将达到100%。非西班牙裔白人和西班牙裔的胆固醇治疗率显著上升。到2011 - 2012年，他汀类药物使用率显著上升至心肌梗死幸存者的73%，阿司匹林使用率显著上升，但到2011 - 2012年仅为28%。血压治疗或控制率在性别上无变化，高血压治疗仅在非西班牙裔黑人中增加。预计高血压控制率仍不理想。
虽然时间趋势表明胆固醇治疗有所改善，但血压治疗和控制未变以及阿司匹林使用率持续较低代表错失了机会。需要采取紧急行动提高预计到2020年的二级预防率，以减少这一高危群体的复发事件。
