Al Shammeri Owayed, Stafford Randall S, Alzenaidi Ahlam, Al-Hutaly Bushra, Abdulmonem Alaa
Owayed Al-Shammeri, MD, Department of Medicine, Qassim University,, PO Box 6655, Buraidah 51452, Saudi Arabia, T: +966 53 272 1010,, F: +966 11 490 4444,
Ann Saudi Med. 2014 Nov-Dec;34(6):488-93. doi: 10.5144/0256-4947.2014.488.
Patients with coronary artery disease (CAD) are at high risk of recurrent adverse cardiac events. Such risk can be diminished through a guideline-recommend optimal medical therapy (OMT), defined as adherence to appropriate antiplatelet therapy, lipid-lowering agents, beta-blockers and angio.tensin-converting enzyme inhibitors, blood pressure < 140/90 mm Hg ( < 130/80 mm Hg in diabetics and renal disease patients), low-density lipoprotein (LDL) < 2 mmol/L, smoking cessation and aerobic physical activity, and hemoglobin (Hb) A1c < 7%. Unfortunately, preliminary data suggest a wide gap between recommended and actual practices. The study aims to estimate the rate of achieving of OMT in CAD patients in Qassim Province.
This observational study enrolled 207 consecutive CAD patients seen in cardiology clinic in Prince Sultan Cardiac Center in Qassim between January 2012 and May 2012.
Eligible participants were over the age of 18, with CAD documented by either noninvasive testing or by coronary angiogram. We collected the demographic, medications, laboratory, and clinical data through in-person interviews, medical records, and an electronic patient database.
OMT was achieved in only 10.4% of CAD patients. The rate of achievement of target systolic blood pressure was 76.5%, target diastolic blood pressure 88%, target LDL 68%, adherence to medications 91%. Diabetes was common (64% of all patients), and only 24% of these patients achieved the target HbA1c.
The poor achievement of optimal medical therapy in CAD patients contributes to prevent.able mortality, morbidity, and health care costs. The observed shortcomings warrant investment in strategies to achieve OMT in these high-risk patients.
冠心病（CAD）患者发生心脏不良事件复发的风险很高。通过指南推荐的最佳药物治疗（OMT）可降低此类风险，OMT定义为坚持适当的抗血小板治疗、降脂药物、β受体阻滞剂和血管紧张素转换酶抑制剂，血压<140/90 mmHg（糖尿病和肾病患者<130/80 mmHg），低密度脂蛋白（LDL）<2 mmol/L，戒烟和进行有氧体育活动，糖化血红蛋白（Hb）A1c<7%。不幸的是，初步数据表明推荐做法与实际做法之间存在很大差距。本研究旨在评估卡西姆省CAD患者的OMT达标率。
这项观察性研究纳入了2012年1月至2012年5月期间在卡西姆苏丹王子心脏中心心脏病诊所连续就诊的207例CAD患者。
符合条件的参与者年龄在18岁以上，通过无创检测或冠状动脉造影确诊为CAD。我们通过面对面访谈、病历和电子患者数据库收集了人口统计学、药物治疗、实验室和临床数据。
仅10.4%的CAD患者实现了OMT。收缩压达标率为76.5%，舒张压达标率为88%，LDL达标率为68%，药物依从率为91%。糖尿病很常见（占所有患者 的64%），这些患者中只有24%达到了HbA1c目标。
CAD患者最佳药物治疗的达标情况不佳导致了可预防的死亡率、发病率和医疗费用。观察到的这些不足值得对这些高危患者实现OMT的策略进行投入。
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