Zhao Min, Graham Ian, Cooney Marie Therese, Grobbee Diederick E, Vaartjes Ilonca, Klipstein-Grobusch Kerstin
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Trinity College Dublin, Dublin, Ireland.
Heart Asia. 2019 Mar 8;11(1):e011112. doi: 10.1136/heartasia-2018-011112. eCollection 2019.
The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.
SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.
Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
风险因素调查（SURF）表明，已确诊冠心病（CHD）患者的风险因素控制不佳。本研究旨在调查冠心病患者风险因素管理的决定因素。
SURF在2012年至2013年间连续招募了来自欧洲、亚洲和中东的9987例冠心病患者。基于六个风险因素目标（非吸烟者/已戒烟者、体重指数<30、适度运动、血压得到控制、低密度脂蛋白得到控制和血糖得到控制），将风险因素管理总结为心血管健康指数评分（CHIS）。逻辑回归模型评估了决定因素（年龄、性别、家族病史、心脏康复、既往住院和糖尿病）与达到中度CHIS（≥3个风险因素得到控制）之间的关联。结果以OR及相应的95%CI表示。女性（OR 0.90，95%CI 0.69至1.00）、年龄<55岁的患者（OR 0.62，95%CI 0.53至0.76）和糖尿病患者（OR 0.41，95%CI 0.37至0.46）达到中度CHIS的可能性较小。参加心脏康复与更好的CHIS成绩相关（OR 1.62，95%CI 1.42至1.87）。亚洲和欧洲的年轻患者风险因素管理较差，而中东患者的年龄与风险因素管理无显著关联。心脏康复的可及性和适用性因地区而异。
总体而言，女性、年龄小于55岁的患者、糖尿病患者以及未参加心脏康复的患者的风险因素管理较差。心血管风险因素管理的决定因素因地区而异。
