INCLIVA Health Research Institute, University of Valencia, Spain; Health Institute Carlos III, CIBEROBN, Madrid, Spain.
INCLIVA Health Research Institute, University of Valencia, Spain.
Int J Cardiol. 2019 Oct 15;293:260-265. doi: 10.1016/j.ijcard.2019.05.071. Epub 2019 May 31.
Drug treatment for secondary prevention of cardiovascular disease is recommended by guidelines, but it is not always followed in real life. This study wanted to assess the size of this gap and its impact on mortality in subjects after a cardiovascular event (MACE).
Patients with any of MACE in the period from January 1st 2011 to December 31st 2013, and more than one year of follow-up were selected from population of the Valencian Community. Drugs for secondary prevention were antiplatelets, renin-angiotensin system blockers and statins. Assessment of treatment was performed one year after the initial event. Mortality risk was assessed using Cox by the number of drug classes (G0 no medication, G1 one, G2 two and G3 three drugs) adjusted by confounders.
A total of 92,436 patients (62% men, mean age 72 years) of whom 60.5% presented with stroke, 30.6% with myocardial infarction and 8.9% with revascularization were included. Among them, 4.1% were G0, 20.2% G1, 32.9% G2 and 42.7% G3. A progressive decrease in mortality was observed in G1 (HR 0.83, CI 95% 0.73-0.95), G2 (HR 0.70, CI 95% 0.60-0.82) and G3 (HR 0.61, CI95% 0.51-0.74) vs. G0. In diabetic subgroup, significant reduction of risk was observed in the G2 (0.79, CI 95% 0.63-0.98) and G3 (0.72, CI9 5% 0.56-0.95), but not in G1 (0.97, CI 95% 0.80-1.17).
A gap between guidelines and reality in the use of cardiovascular protecting drugs one year after the initial event still exists and it is largely related with all-cause late mortality.
心血管疾病二级预防的药物治疗被指南推荐，但在现实生活中并不总是遵循。本研究旨在评估这一差距的大小及其对心血管事件（MACE）后患者死亡率的影响。
从巴伦西亚社区人群中选择 2011 年 1 月 1 日至 2013 年 12 月 31 日期间发生任何 MACE 的患者，随访时间超过 1 年。二级预防药物为抗血小板药物、肾素-血管紧张素系统抑制剂和他汀类药物。在初始事件发生一年后进行治疗评估。使用 Cox 按药物种类（G0 无药物治疗、G1 一种药物、G2 两种药物和 G3 三种药物）评估死亡率风险，调整混杂因素。
共纳入 92436 例患者（62%为男性，平均年龄 72 岁），其中 60.5%为中风、30.6%为心肌梗死和 8.9%为血运重建。其中，4.1%为 G0、20.2%为 G1、32.9%为 G2 和 42.7%为 G3。G1（HR0.83，95%CI0.73-0.95）、G2（HR0.70，95%CI0.60-0.82）和 G3（HR0.61，95%CI0.51-0.74）组死亡率逐渐降低，与 G0 相比差异有统计学意义。在糖尿病亚组中，G2（0.79，95%CI0.63-0.98）和 G3（0.72，95%CI0.56-0.95）组风险显著降低，但 G1 组（0.97，95%CI0.80-1.17）组无差异。
初始事件后一年，心血管保护药物的使用与指南之间仍存在差距，这主要与全因晚期死亡率有关。
