Chmelík Zdeněk, Vaclová Martina, Lánská Věra, Laštůvka Jiří, Vrablík Michal
Third Department of Internal Medicine, Department of Endocrinology, Metabolism, First Medical Faculty, Charles University, General Faculty Hospital, Prague, Czech Republic.
Department of Hygiene, Institute of Clinical, Experimental Medicine, Prague, Czech Republic.
Cent Eur J Public Health. 2020 Jun;28(2):114-119. doi: 10.21101/cejph.a5730.
The aim of this analysis was to analyze the presence of the most important cardiovascular (CV) risk factors and to discuss patterns of LDL cholesterol management in the population studied.
We enrolled 961 males, average age of 42.9 ± 4.7, and 851 females, average age of 51.2 ± 3.6. Data on personal, pharmacological and family history, and laboratory examinations were collected. Cardiovascular (CV) risk was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm with modifications according to the guidelines.
The distribution of CV risk in the observed cohort was as follows: 24% of the subjects had low, 51% moderate, 17% high and 8% very high risk. The percentage of patients who reached target values of LDL cholesterol was dramatically lower in the groups with very high (1%) and high (3%) risk than in the groups with moderate (14%) or low risk (59%). Dyslipidemia was newly identified in 20% of both sexes. Arterial hypertension was newly diagnosed in 8% of males and 5% of females, and type 2 diabetes mellitus was newly diagnosed in 3% of both the males and females. Dyslipidemia was present in 39% of males and 41% of females; arterial hypertension in 43% of males and 45% of females, and type 2 diabetes mellitus was diagnosed in 11% of the subjects of both sexes. 49% of males and 31% of females were overweight and 32% of both genders were obese. There were 36% of male smokers and 22% of female smokers. 48% of the participants were pharmacologically treated. Non-pharmacological treatment was recommended to 62% of male and to 65% of female participants. Pharmacological intervention was started in 53% of males and 51% of females. In both gender antihypertensive treatment with angiotensin-converting enzyme (ACE) inhibitors (29% of males and 27% of females) and lipid lowering therapy with a statin (28% of males, 27% of females) were the most commonly initiated treatments. In the subgroup of the 101 patients with LDL cholesterol levels > 5 mmol/L 56% were not treated with a statin. The analysis of relationship between the positive family history of any of the followed CV risks showed significant increases of the risk for arterial hypertension, type 2 diabetes mellitus and dyslipidemia.
European guidelines suggest general screening for risk factors, including analysis of lipid profiles in the population of 40-year-old males and 50-year-old or postmenopausal women. Our study documents high prevalence and incidence of CV risk factors together with insufficient control of the risk factors in Czech patients of this age range. This finding suggests that preventive examinations should be undertaken earlier (e.g., in 30-year-old males and 40-year-old women). Exact timing of the preventive check-ups to yield the best cost-benefit ratio needs to be verified.
本分析旨在分析最重要的心血管（CV）危险因素的存在情况，并探讨所研究人群中低密度脂蛋白胆固醇的管理模式。
我们纳入了961名男性，平均年龄为42.9±4.7岁，以及851名女性，平均年龄为51.2±3.6岁。收集了个人、用药及家族史以及实验室检查的数据。使用系统性冠状动脉风险评估（SCORE）算法并根据指南进行修改来计算心血管（CV）风险。
观察队列中CV风险的分布如下：24%的受试者风险较低，51%为中度，17%为高度，8%为极高风险。极高风险组（1%）和高风险组（3%）中达到低密度脂蛋白胆固醇目标值的患者百分比显著低于中度风险组（14%）或低风险组（59%）。20%的男性和女性新发现血脂异常。8%的男性和5%的女性新诊断为动脉高血压，3%的男性和女性新诊断为2型糖尿病。39%的男性和41%的女性存在血脂异常；43%的男性和45%的女性患有动脉高血压，11%的男性和女性被诊断为2型糖尿病。49%的男性和31%的女性超重，32%的男女肥胖。36%的男性和22%的女性吸烟。48%的参与者接受了药物治疗。62%的男性和65%的女性参与者被建议进行非药物治疗。53%的男性和51%的女性开始了药物干预。在男性和女性中，使用血管紧张素转换酶（ACE）抑制剂进行降压治疗（男性为29%，女性为27%）以及使用他汀类药物进行降脂治疗（男性为28%，女性为27%）是最常开始的治疗方法。在低密度脂蛋白胆固醇水平>5 mmol/L的101例患者亚组中，56%未接受他汀类药物治疗。对任何一种后续CV风险的阳性家族史之间关系的分析显示，动脉高血压、2型糖尿病和血脂异常的风险显著增加。
欧洲指南建议对危险因素进行常规筛查，包括对40岁男性和50岁或绝经后女性人群进行血脂谱分析。我们的研究记录了该年龄范围的捷克患者中CV危险因素的高患病率和发病率，以及危险因素控制不足的情况。这一发现表明应更早地进行预防性检查（例如，30岁男性和40岁女性）。产生最佳成本效益比的预防性检查的确切时间需要进一步验证。
