Birck Marina Gabriela, Goulart Alessandra Carvalho, Lotufo Paulo Andrade, Benseñor Isabela Martins
BSc, MSc. Postgraduate Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário da Universidade de São Paulo (HU-USP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2019 Aug 29;137(3):223-233. doi: 10.1590/1516-3180.2018.0531140319.
Coronary heart disease (CHD) remains a major cause of mortality worldwide and in Brazil. Use of standard medications after CHD has been proven to avoid new events and reduce early mortality.
This study aimed to analyze secondary prevention of CHD and its association with the baseline characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Cross-sectional analysis on ELSA-Brasil data.
Secondary prevention of CHD recommended in standard guidelines (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without angiotensin-converting enzyme inhibitors, ACEI, or angiotensin receptor blockers, ARB) was evaluated in relation to sociodemographic data and the time since the coronary event. The chi-square test, one-way analysis of variance (ANOVA) and Mann-Whitney test were performed, as necessary.
Among 15,094 participants, 2.7% reported a previous diagnosis of CHD. Use of recommended drugs for secondary prevention was reported by almost 35% of the participants. Medication use for secondary prevention was generally more frequent among high-income participants than among low-income participants. Use of ARB and ACEI was different between participants who had private health insurance and those who only used the public healthcare system. Men were more likely to use medication than women. The frequency with which participants used the recommended drugs was similar in all time periods after CHD, but use of only one drug increased progressively across time periods.
The use of medication for secondary prevention of CHD was lower than what is recommended in standardized guidelines, especially among women and lower-income participants.
冠心病（CHD）仍是全球及巴西的主要死因。冠心病后使用标准药物已被证明可避免新的事件并降低早期死亡率。
本研究旨在分析冠心病的二级预防及其与巴西成人健康纵向研究（ELSA - Brasil）基线特征的关联。
对ELSA - Brasil数据进行横断面分析。
根据社会人口统计学数据和冠心病事件后的时间，评估标准指南中推荐的冠心病二级预防措施（抗血小板药物加β受体阻滞剂加降脂药物，有或没有血管紧张素转换酶抑制剂、ACEI，或血管紧张素受体阻滞剂、ARB）。必要时进行卡方检验、单因素方差分析（ANOVA）和曼 - 惠特尼检验。
在15,094名参与者中，2.7%报告曾被诊断为冠心病。近35%的参与者报告使用了推荐的二级预防药物。高收入参与者中二级预防药物的使用通常比低收入参与者更频繁。有私人健康保险的参与者与仅使用公共医疗系统的参与者在ARB和ACEI的使用上存在差异。男性比女性更有可能使用药物。冠心病后所有时间段参与者使用推荐药物的频率相似，但仅使用一种药物的情况随时间逐渐增加。
冠心病二级预防药物的使用低于标准化指南中的推荐水平，尤其是在女性和低收入参与者中。
