Khetan Aditya, Zullo Melissa, Hejjaji Vittal, Barbhaya Dweep, Agarwal Sushil, Gupta Rishab, Madan Mohan Sri Krishna, Josephson Richard
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, Ohio, USA.
Kent State University, Kent, Ohio, USA.
Heart Asia. 2017 Sep 14;9(2):e010931. doi: 10.1136/heartasia-2017-010931. eCollection 2017.
Cardiovascular disease is the leading cause of mortality in India. Since it is largely driven by risk factors such as hypertension, diabetes and smoking, it is important to study the treatment cascade for these conditions and identify areas for improvement.
This is a cross-sectional study from Project SEHAT (Study to Enhance Heart Associated Treatments), an ongoing cluster randomised controlled trial testing the hypothesis that a community health worker-led intervention can improve the control of cardiovascular risk factors in a community in West Bengal, India. For the baseline data, 3556 adults, between the ages of 35 and 70, were screened for hypertension, diabetes and smoking. For hypertension and diabetes, an elevated reading was confirmed on a repeat visit.
18.3% (n=650), 9.0% (n=317) and 14.1% (n=500) of adults were diagnosed with hypertension, diabetes and smoking, respectively. Overall, 35.0% (n=1242) adults had at least one of the three risk factors. 55.1% (n=358) of participants with hypertension and 40.4% (n=128) of participants with diabetes were unaware of their respective condition. 36.6% (n=238) of those with hypertension and 58.0% (n=184) of diabetics were on treatment. 8.2% (n=53) hypertensives were controlled (blood pressure <140/90 mm Hg) while 13.6% (n=43) diabetics were controlled (defined as fasting blood sugar <126 mg/dL). Less than 1% diabetics were on insulin, and average number of medications for a patient with hypertension was 1.2.
In our population in semiurban India, one in three adults have a major cardiovascular risk factor, with low control rates. There is a large burden of undiagnosed cardiovascular risk factors and a large gap between treatment and control, which may be explained by lack of treatment intensification.
心血管疾病是印度的主要死因。由于其很大程度上由高血压、糖尿病和吸烟等风险因素驱动，研究这些疾病的治疗流程并确定改进领域很重要。
这是一项来自“加强心脏相关治疗研究”（SEHAT项目）的横断面研究，该项目是一项正在进行的整群随机对照试验，旨在验证由社区卫生工作者主导的干预措施能否改善印度西孟加拉邦一个社区中心血管危险因素的控制情况。对于基线数据，对3556名年龄在35至70岁之间的成年人进行了高血压、糖尿病和吸烟筛查。对于高血压和糖尿病，在复诊时确认读数升高。
分别有18.3%（n = 650）、9.0%（n = 317）和14.1%（n = 500）的成年人被诊断患有高血压、糖尿病和吸烟。总体而言，35.0%（n = 1242）的成年人至少有这三种风险因素中的一种。55.1%（n = 358）的高血压参与者和40.4%（n = 128）的糖尿病参与者不知道自己的病情。36.6%（n = 238）的高血压患者和58.0%（n = 184）的糖尿病患者正在接受治疗。8.2%（n = 53）的高血压患者血压得到控制（血压<140/90 mmHg），而13.6%（n = 43）的糖尿病患者血糖得到控制（定义为空腹血糖<126 mg/dL）。不到1%的糖尿病患者使用胰岛素，高血压患者的平均用药数量为1.2种。
在我们印度半城市地区的人群中，三分之一的成年人有主要心血管危险因素，控制率较低。未诊断出的心血管危险因素负担沉重，治疗与控制之间存在很大差距，这可能是由于缺乏强化治疗所致。
