Figliuzzi Ilaria, Presta Vivianne, Citoni Barbara, Miceli Francesca, Simonelli Francesca, Battistoni Allegra, Coluccia Roberta, Ferrucci Andrea, Volpe Massimo, Tocci Giuliano
Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
IRCCS Neuromed, Pozzilli, Italy.
Clin Cardiol. 2018 Jun;41(6):788-796. doi: 10.1002/clc.22955. Epub 2018 Jun 5.
Pharmacological therapy in patients at high cardiovascular (CV) risk should be tailored to achieve recommended therapeutic targets.
To evaluate individual global CV risk profile and to estimate the control rates of multiple therapeutic targets for in adult outpatients followed in real practice in Italy.
Data extracted from a cross-sectional, national medical database of adult outpatients in real practice in Italy were analyzed for global CV risk assessment and rates of control of major CV risk factors, including hypertension, dyslipidemia, diabetes, and obesity. CV risk characterization was based on the European SCORE equation and the study population stratified into 3 groups: low risk (<2%), intermediate risk (≥2%-<5%), and high to very high risk (≥5%).
We analyzed data from 7158 adult outpatients (mean age, 57.7 ±5.3 years; BMI, 28.3 ±5.0 kg/m , BP, 136.0 ±14.3/82.2 ±8.3 mm Hg; total cholesterol, 212.7 ±40.7 mg/dL), among whom 2029 (45.2%) had low, 1730 (24.2%) intermediate, and 731 (16.3%) high to very high risk. Increased SCORE risk was an independent predictor of poor achievement of diastolic BP <90 mm Hg (OR: 0.852, 95% CI: 0.822-0.882), LDL-C < 130 mg/dL (OR: 0.892, 95% CI: 0.861-0.924), HDL-C > 40 (males)/>50 (females) mg/dL (OR: 0.926, 95% CI: 0.895-0.958), triglycerides <160 mg/dL (OR: 0.925, 95% CI: 0.895-0.957), and BMI <25 kg/m (OR: 0.888, 95% CI: 0.851-0.926), even after correction for diabetes, renal function, pharmacological therapy, and referring physicians (P < 0.001).
Despite low prevalence and optimal medical therapy, individuals with high to very high SCORE risk did not achieve recommended therapeutic targets in a real-world practice.
心血管（CV）高风险患者的药物治疗应进行调整，以实现推荐的治疗目标。
评估意大利实际随访的成年门诊患者的个体整体CV风险状况，并估计多个治疗目标的控制率。
从意大利实际随访的成年门诊患者的全国横断面医学数据库中提取数据，用于整体CV风险评估以及主要CV风险因素（包括高血压、血脂异常、糖尿病和肥胖）的控制率分析。CV风险特征基于欧洲SCORE方程，研究人群分为3组：低风险（<2%）、中度风险（≥2%-<5%）和高至极高风险（≥5%）。
我们分析了7158例成年门诊患者的数据（平均年龄57.7±5.3岁；体重指数28.3±5.0kg/m²，血压136.0±14.3/82.2±8.3mmHg；总胆固醇212.7±40.7mg/dL），其中2029例（45.2%）为低风险，1730例（24.2%）为中度风险，731例（16.3%）为高至极高风险。即使在校正糖尿病、肾功能、药物治疗和转诊医生后，SCORE风险增加仍是舒张压<90mmHg（比值比：0.852，95%置信区间：0.822-0.882）、低密度脂蛋白胆固醇<130mg/dL（比值比：0.892，95%置信区间：0.861-0.924）、高密度脂蛋白胆固醇>40（男性）/>50（女性）mg/dL（比值比：0.926，95%置信区间：0.895-0.958）、甘油三酯<160mg/dL（比值比：0.925，95%置信区间：0.895-0.957）和体重指数<25kg/m²（比值比：0.888，95%置信区间：0.851-0.926）未达标的独立预测因素（P<0.001）。
尽管患病率较低且采用了优化的药物治疗，但在实际临床实践中，SCORE风险高至极高的个体仍未达到推荐的治疗目标。
