Irewall Anna-Lotta, Ögren Joachim, Bergström Lisa, Laurell Katarina, Söderström Lars, Mooe Thomas
Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
Department of Pharmacology and Clinical Neuroscience, Östersund, Umeå University, Umeå, Sweden.
Trials. 2019 Jan 15;20(1):52. doi: 10.1186/s13063-018-3131-4.
The objective of this study was to analyze the impact of two forms of secondary preventive follow-up on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA).
We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based age-independent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups.
Among controls, systolic BP (SBP) decreased only among the highly educated (-2.5 mm Hg, 95% confidence interval (CI) -0.2 to -4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (-0.3 mmol/L, 95% CI -0.2 to -0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5).
Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education.
ISRCTN Registry ISRCTN23868518 , June 19, 2012 - Retrospectively registered.
本研究的目的是分析两种二级预防随访形式对卒中/短暂性脑缺血发作（TIA）后教育水平与血压（BP）及低密度脂蛋白胆固醇（LDL-C）水平之间关联的影响。
我们纳入了一个基于人群的队列，共771例卒中及TIA患者，于2010年1月1日至2013年12月31日期间被随机分配（1:1）至初级卫生保健机构的二级预防随访（对照组）或由护士主导的电话随访（干预组），这是NAILED（基于护士的年龄无关性干预以限制疾病进展）卒中危险因素试验的一部分。我们分别比较了干预组和对照组出院12个月后的BP和LDL-C水平与教育水平（低，≤10年；高，>10年）的关系。
在对照组中，仅高学历者的收缩压（SBP）下降（-2.5 mmHg，95%置信区间（CI）-0.2至-4.8），而低学历组的LDL-C升高（0.2 mmol/L，95% CI 0.1至0.3）。在12个月时，年龄不超过70岁的低学历对照组患者的SBP高于同年龄的高学历对照组患者（5.8 mmHg，95% CI 1.0至10.6）。相比之下，干预组的SBP无论教育水平如何均有相似程度的下降，低学历者的LDL-C下降（-0.3 mmol/L，95% CI -0.2至-0.4），并且在年龄不超过70岁的亚组中，低学历参与者在12个月时的LDL-C低于高学历者（0.3 mmol/L，95% CI 0.1至0.5）。
由护士主导的电话二级预防随访使各教育组的血压得到了类似程度的改善，而常规随访对低学历者不利。
ISRCTN注册库ISRCTN23868518，2012年6月19日 - 回顾性注册。
