Department of Cardiology, Toulouse Rangueil University Hospital (CHU), Toulouse, France; Department of Epidemiology and Public Health, UMR INSERM 1027, INSERM - Université de Toulouse, Toulouse, France.
Merck & Co., Inc., Kenilworth, NJ, USA.
Int J Cardiol. 2018 Nov 1;270:21-27. doi: 10.1016/j.ijcard.2018.06.008. Epub 2018 Jun 6.
Guidelines recommend lifestyle modification and medications to control risk factors in coronary heart disease (CHD). Using data from the observational DYSIS II study, we sought to evaluate the use of guideline-recommended treatments at discharge for acute coronary syndromes (ACS) or in the chronic phase for CHD, and participation in rehabilitation/secondary prevention programs.
Between 2013 and 2014, 10,661 patients (3867 with ACS, 6794 with stable CHD) were enrolled in 332 primary and secondary care centers in 18 countries (Asia, Europe, Middle East). Patients with incident ACS were younger and more likely to be smokers than patients with recurrent ACS or stable CHD (both p < 0.0001). Sedentary lifestyle was common (44.4% of ACS patients; 44.2% of stable CHD patients); 22.8% of ACS patients and 24.3% of stable CHD patients were obese. Prevalence of low high-density lipoprotein cholesterol (<40 mg/dL in men/50 mg/dL in women) was 46.9% in chronic CHD and 55.0% in ACS. Rates of secondary prevention medications were lower among CHD versus ACS (all p < 0.0001): antiplatelet 94.3% vs 98.0%, beta-blocker 72.0% vs 80.0%, lipid-lowering therapy 94.7 vs 97.5%, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 69.4% vs 73.7%, respectively. Attendance at cardiac rehabilitation (16.8% of patients with a first ACS, 10.8% with recurrent ACS) or a secondary prevention program (3.7% of ACS and 11.7% of stable CHD patients) was infrequent.
The high prevalence of risk factors in all CHD patients and reduced rates of secondary prevention medications in stable CHD offer areas for improvement.
The findings of DYSIS II may reinforce the importance of adopting a healthy lifestyle and prescribing (by clinicians) and adhering (by patients) to evidence-based medications in the management of CHD, not only during the short term but also over the longer term after a cardiac ischemic event. The results may help to increase the proportion of ACS patients who are referred to cardiac rehabilitation centres.
指南建议通过生活方式改变和药物治疗来控制冠心病（CHD）的风险因素。本研究利用观察性 DYSIS II 研究的数据，评估了急性冠状动脉综合征（ACS）患者出院时以及 CHD 慢性期时采用指南推荐治疗方法的情况，并评估了他们参与康复/二级预防项目的情况。
2013 年至 2014 年，在 18 个国家（亚洲、欧洲、中东）的 332 个初级和二级保健中心共纳入 10661 例患者（ACS 患者 3867 例，稳定型 CHD 患者 6794 例）。新发 ACS 患者比复发性 ACS 或稳定型 CHD 患者更年轻，且更可能为吸烟者（均 P＜0.0001）。久坐的生活方式很常见（ACS 患者中为 44.4%；稳定型 CHD 患者中为 44.2%）；22.8%的 ACS 患者和 24.3%的稳定型 CHD 患者为肥胖。低高密度脂蛋白胆固醇（男性＜40mg/dL，女性＜50mg/dL）的患病率在慢性 CHD 中为 46.9%，在 ACS 中为 55.0%。与 ACS 相比，CHD 患者接受二级预防药物治疗的比例较低（均 P＜0.0001）：抗血小板药物 94.3%比 98.0%，β受体阻滞剂 72.0%比 80.0%，降脂药物 94.7%比 97.5%，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂 69.4%比 73.7%。首次 ACS 患者中仅 16.8%、复发性 ACS 患者中仅 10.8%参加了心脏康复，或参加了二级预防项目（ACS 患者中为 3.7%，稳定型 CHD 患者中为 11.7%）。
所有 CHD 患者的危险因素高发，且稳定型 CHD 患者的二级预防药物治疗率较低，这表明有必要改善这种情况。
为了方便读者理解，译文添加了句号和换行符。
译文“Secondary prevention medications”和“cardiac rehabilitation”均为医疗专业术语，分别指“二级预防药物”和“心脏康复”。
