Guo L H, Zhong J M, Fang L, Chen X Y, Gong W W, Xie K X, Wang C M
Department of Chronic Non-communicable Diseases Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
Department of Chronic Non-communicable Diseases Control and Prevention, Tongxiang Center for Disease Control and Prevention, Tongxiang 314500, Zhejiang Province, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2020 Apr 6;54(4):411-415. doi: 10.3760/cma.j.cn112150-20190606-00453.
To evaluate the effect of comprehensive intervention combined with clinical preventive services and lifestyle adjustment on high-risk populations of cardiovascular disease. In 2015, 4 towns (streets) in Tongxiang City, of Zhejiang Province including Heshan Town, Longxiang Street, Wutong Street, and Fengming Street, were selected by using the typical sampling. The towns (streets) were allocated to the intervention group (Heshan Town and Longxiang Street) and the control group (Wutong Street and Fengming Street) by using the cluster random sampling. In each town (street), hypertension patients aged 50 to 74 years old who were taking community medicine management and with a 10-year cardiovascular disease risk ≥10% were recruited as subjects. There were 1 823 subjects in the intervention group and 1 883 in the control group. The intervention group was given a 1-year comprehensive intervention combining clinical preventive services and lifestyle adjustment, while the control group received routine chronic disease management. After the intervention, the final questionnaire investigation was conducted and health physical examination data were obtained. The death, acute coronary heart disease events and stroke incidence were the primary outcomes, and cardiovascular disease-related knowledge and behavior, clinical preventive services utilization, physical changes, blood fat index and 10-year cardiovascular disease risk were the secondary outcomes. The difference-in-difference model was used to evaluate the effects of interventions. The age of subjects in the intervention and control group was (68.76±3.75) and (67.90±4.56) years old, respectively. After 1-year intervention, the incidence of mortality, acute coronary events and stroke in intervention group was 1.65% (30 cases), 0.27% (5 cases) and 2.69% (49 cases), respectively, which showed no statistical difference compared to the control group [1.33% (25 cases), 0.32% (6 cases) and 2.07% (39 cases)]. After adjusting for the age, gender, education, marital status, self-assessed family income level and situation of taking antihypertensive drugs, the difference-in-difference model showed that the body mass index and diastolic blood pressure in the intervention group decreased by 0.33 kg/m(2) and 1.49 mmHg (1 mmHg=0.133 kPa). Compared with the control group, daily vegetable consumption proportion, the awareness rates of aspirin, stains, salt intake, and oil intake increased by 4.76%, 26.22%, 29.56%, 10.80%, and 15.17%, respectively (0.05). After the 1-year comprehensive intervention, there was no significant change in primary outcomes among high-risk populations of cardiovascular disease. In secondary outcomes, body mass index and diastolic blood pressure declined and cardiovascular disease-related knowledge awareness increased.
评估综合干预联合临床预防服务及生活方式调整对心血管疾病高危人群的影响。2015年，采用典型抽样法选取浙江省桐乡市的4个镇（街道），即河山镇、龙翔街道、梧桐街道和凤鸣街道。通过整群随机抽样将这些镇（街道）分为干预组（河山镇和龙翔街道）和对照组（梧桐街道和凤鸣街道）。在每个镇（街道），招募年龄在50至74岁、正在接受社区药物管理且10年心血管疾病风险≥10%的高血压患者作为研究对象。干预组有1823名研究对象，对照组有1883名。干预组接受为期1年的综合干预，包括临床预防服务和生活方式调整，而对照组接受常规慢性病管理。干预结束后，进行最终问卷调查并获取健康体检数据。死亡、急性冠心病事件和中风发病率为主要结局指标，心血管疾病相关知识和行为、临床预防服务利用情况、身体变化、血脂指标及10年心血管疾病风险为次要结局指标。采用差值法模型评估干预效果。干预组和对照组研究对象的年龄分别为（68.76±3.75）岁和（67.90±4.56）岁。经过1年干预，干预组的死亡率、急性冠心病事件和中风发病率分别为1.65%（30例）、0.27%（5例）和2.69%（49例），与对照组[1.33%（25例）、0.32%（6例）和2.07%（39例）]相比，差异无统计学意义。在调整年龄、性别、教育程度、婚姻状况、自我评估家庭收入水平及服用降压药情况后，差值法模型显示干预组的体重指数和舒张压分别下降了0.33kg/m²和1.49mmHg（1mmHg = 0.133kPa）。与对照组相比，干预组的每日蔬菜食用比例、阿司匹林、他汀类药物、盐摄入量及油摄入量的知晓率分别提高了4.76%、26.22%、29.56%、10.80%和15.17%（P<0.05）。经过1年的综合干预，心血管疾病高危人群的主要结局指标无显著变化。在次要结局指标方面，体重指数和舒张压下降，心血管疾病相关知识知晓率提高。
