Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
Glob Heart. 2017 Dec;12(4):305-313. doi: 10.1016/j.gheart.2016.06.001. Epub 2016 Oct 20.
Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America.
This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke.
In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model.
Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention.
There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
尽管有循证治疗方法，但在南美洲的城市和农村社区环境中，关于心血管疾病二级预防药物使用的信息仍然缺乏。
本研究旨在评估有冠心病或中风病史的个体中有效二级预防治疗的使用情况及其预测因素。
在 PURE（前瞻性城乡流行病学）研究中，我们从阿根廷、巴西、智利和哥伦比亚的 97 个农村和城市社区招募了年龄在 35 至 70 岁之间的 24713 名南美人。我们使用标准化问卷评估了已证实的治疗方法的使用情况。我们报告了药物在国家、社区和个体层面的使用情况，并通过多变量分析模型报告了其使用的独立预测因素。
在 24713 名个体中，910 人有自我报告的冠心病事件（中位数为 5 年前），407 人有中风（6 年前）。冠心病患者接受抗血小板药物（30.1%）、β受体阻滞剂（34.2%）、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（36.0%）或他汀类药物（18.0%）的比例较低；中风患者的比例更低（抗血小板药物 24.3%、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂 37.6%、他汀类药物 9.8%）。相当一部分患者未接受任何已证实的治疗（冠心病 31%，中风 54%）。少数患者接受了 4 种（4.1%）或 3 种（3.3%）已证实的治疗。男性、年龄>60 岁、较高的教育程度、更多的财富、城市居住、糖尿病和肥胖与更高的药物使用率相关。在多变量模型中，财富标志物对二级预防的影响最大。
在南美洲，心血管疾病二级预防中有效药物的使用存在很大差距。改善这些药物持续使用的策略可能会大大降低心血管疾病负担。
