伊朗戈勒斯坦省心血管疾病二级预防中的药物使用：戈勒斯坦队列研究结果
Drug Use for Secondary Prevention of Cardiovascular Diseases in Golestan, Iran: Results From the Golestan Cohort Study.
作者信息
Nalini Mahdi, Sepanlou Sadaf G, Pourshams Akram, Poustchi Hossein, Sharafkhah Maryam, Bahrami Hossein, Kamangar Farin, Malekzadeh Reza
机构信息
Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
出版信息
Arch Iran Med. 2018 Mar 1;21(3):86-94.
BACKGROUND
Little is known about secondary prevention of cardiovascular diseases, using cardio-protective drugs, in the community-level, especially in low- and middle-income countries. We aimed to assess main drug use and its predictors in Northeast of Iran.
METHODS
This is a cross-sectional analysis on the Golestan Cohort Study data (2004-2008) with 50 045 participants. We assessed drug use in those with a history of ischemic heart disease (IHD) or stroke, recorded by face-to-face interviews. We explored drug use predictors (i.e., age, gender, wealth, education, residency, smoking, body mass index, physical activity, hypertension, and diabetes) through multivariable logistic regression.
RESULTS
A total of 3371 (6.7%) participants (56.7 ± 9.0 years, 58.1% female) reported a history of IHD, stroke or both. Median duration since diagnosis was 3.14 years (IQR: 1.25-6.30). Rates of using anti-platelets, statins, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and beta-blockers were 28.8% (95% CI: 27.3-30.3), 5.4 (4.7-6.2), 15.7 (14.5-17.0), and 40.6 (38.9-42.3), respectively. About 43% (41 - 45) of patients did not use any protective drugs. Use of ≥ three drugs was only 7.3% (6.6-8.2). Indicators of ≥1 drug use were: older age (OR for ≥60 vs. <50: 1.37), high wealth score (fifth vs first quintile: 1.60), literacy (1.56), city dwelling (1.32), body mass index (<18.5 and ≥30 vs. 25-29: 0.55 and 1.25, respectively), physical activity (third vs. first tertile: 0.64), hypertension (3.47), and diabetes (1.29); (all P < 0.05).
CONCLUSION
Drug use after IHD or stroke is low in Northeast of Iran. Comprehensive efforts to promote secondary prevention are urgently needed.
背景
在社区层面，尤其是在低收入和中等收入国家，关于使用心脏保护药物进行心血管疾病二级预防的情况知之甚少。我们旨在评估伊朗东北部主要药物的使用情况及其预测因素。
方法
这是一项对戈勒斯坦队列研究数据（2004 - 2008年）进行的横断面分析，共有50045名参与者。我们通过面对面访谈评估了有缺血性心脏病（IHD）或中风病史者的药物使用情况。我们通过多变量逻辑回归探索了药物使用的预测因素（即年龄、性别、财富、教育程度、居住情况、吸烟、体重指数、身体活动、高血压和糖尿病）。
结果
共有3371名（6.7%）参与者（年龄56.7±9.0岁，女性占58.1%）报告有IHD、中风或两者的病史。自诊断以来的中位时间为3.14年（四分位间距：1.25 - 6.30）。使用抗血小板药物、他汀类药物、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂以及β受体阻滞剂的比例分别为28.8%（95%置信区间：27.3 - 30.3）、5.4（4.7 - 6.2）、15.7（14.5 - 17.0）和40.6（38.9 - 42.3）。约43%（41 - 45）的患者未使用任何保护药物。使用≥三种药物的比例仅为7.3%（6.6 - 8.2）。使用≥1种药物的指标为：年龄较大（≥60岁与<50岁相比的比值比：1.37）、高财富得分（第五分位数与第一分位数相比：1.60）、识字（1.56）、居住在城市（1.32）、体重指数（<18.5和≥30与25 - 29相比：分别为0.55和1.25）、身体活动（第三三分位数与第一三分位数相比：0.64）、高血压（3.47）和糖尿病（1.29）；（所有P<0.05）。
结论
伊朗东北部IHD或中风后的药物使用率较低。迫切需要做出全面努力来促进二级预防。
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