Sverre Elise, Peersen Kari, Husebye Einar, Gjertsen Erik, Gullestad Lars, Moum Torbjørn, Otterstad Jan Erik, Dammen Toril, Munkhaugen John
Department of Medicine, Drammen Hospital, 3004, Drammen, Norway.
Department of Medicine, Vestfold Hospital, Tonsberg, Norway.
BMC Cardiovasc Disord. 2017 Jan 21;17(1):40. doi: 10.1186/s12872-016-0387-z.
Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event.
A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up.
Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed.
The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits.
Registered at ClinicalTrials.gov (ID NCT02309255 ).
在最近一项欧洲多中心研究中，冠状动脉事件后的危险因素控制情况并不理想。然而，从学术中心选择患者以及参与率较低，可能突出了常规临床实践中危险因素控制的失败。为了改进二级预防策略，需要更好地了解影响危险因素控制的患者因素。本文的目的是确定常规临床实践中冠状动脉疾病患者主要危险因素的控制情况，以及研究因素年龄、性别、冠状动脉事件数量和距索引事件的时间对危险因素控制的影响。
一项横断面研究确定了1127名年龄在18 - 80岁、患有急性心肌梗死和/或血管重建的患者（参与率83%）的危险因素控制情况及其与研究因素的关联，这些患者是从医疗记录中识别出来的。研究数据通过自我报告问卷、临床检查以及在2 - 36个月（中位数16个月）随访后的血样收集。
随访时21%的患者为当前吸烟者。在索引事件时吸烟的患者中，56%继续吸烟。34%的患者存在肥胖，60%的患者身体活动不足。尽管93%的患者正在服用降压药和他汀类药物，但随访时仍有46%的患者患有高血压，57%的患者低密度脂蛋白胆固醇>1.8 mmol/L。59%的患者糖尿病控制不佳。患者平均未能控制六个主要危险因素中的三个，发生>1次冠状动脉事件的患者总体控制最差（p < 0.001）。观察到随着事件发生时间的增加，吸烟（p < 0.01）和肥胖（p < 0.05）呈线性增加。
在具有代表性的挪威人群中，大多数冠状动脉疾病患者未能实现危险因素控制，发生多次冠状动脉事件的患者总体控制最差。显然需要新的二级预防策略来改善危险因素控制。即使是适度的进展也将带来重大的健康益处。
在ClinicalTrials.gov注册（ID NCT02309255）
