Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia.
Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720946949. doi: 10.1177/2150132720946949.
Cardiovascular disease, especially coronary disease, represents one of the main causes of morbidity and mortality. To determine the drug prescription profile for primary cardiovascular prevention prior to a first acute coronary syndrome event. Cross-sectional study. We included adult patients of any sex affiliated with one healthcare insurer of the Colombian Health System, with a diagnosis of a first episode of acute coronary syndrome that occurred during the period of 2015 to 2016. Sociodemographic, clinical and pharmacological variables were evaluated from clinical records. The cardiovascular risk score prior to the event was calculated, and the need for the use of statins and aspirin in primary prevention was defined according to the recommendations of clinical practice guidelines. Clinical records of 322 patients were reviewed with mean age of 61.9 ± 10.8 years, and 77.3% were men. The most frequent comorbidities were dyslipidemia (64.3%), arterial hypertension (62.7%) and diabetes mellitus (30.1%); 22% of the patients were obese, and 33.5% were smokers. The cardiovascular risk score was calculated in 211 patients (65.5%) who had the necessary variables complete. The median 10-year risk according to Framingham risk score was 21.4%, and it was 16.3% according to the American Heart Association. From the 211 patients with risk scores, there were 179 (84.8%) who needed statins (175 of high intensity, 97.8%), and 88 (27.3%) required aspirin as a primary prevention; however, 56 of these patients (31.3%) did not receive any statins, 127 (72.6%) did not receive the high intensity statin they needed, and 38 (43.2% of those with indication) lacked aspirin. Real-life data show that among a group of patients with high cardiovascular risk, a substantial proportion were not receiving medications for primary prevention necessary to reduce their risk and finally suffered an acute coronary event.
心血管疾病，特别是冠心病，是发病率和死亡率的主要原因之一。本研究旨在确定首次急性冠状动脉综合征（ACS）事件前的主要心血管疾病一级预防的药物处方模式。这是一项横断面研究。我们纳入了 2015 年至 2016 年期间，隶属于哥伦比亚卫生系统某一医疗保险公司的患有首次 ACS 发作的任何性别成年患者。从临床记录中评估了社会人口统计学、临床和药理学变量。根据临床实践指南的建议，计算了事件发生前的心血管风险评分，并定义了他汀类药物和阿司匹林在一级预防中的使用需求。共回顾了 322 例患者的临床记录，平均年龄为 61.9±10.8 岁，77.3%为男性。最常见的合并症为血脂异常（64.3%）、动脉高血压（62.7%）和糖尿病（30.1%）；22%的患者肥胖，33.5%为吸烟者。在 211 例（65.5%）完成了必要变量的患者中计算了心血管风险评分。根据Framingham 风险评分，中位数 10 年风险为 21.4%，根据美国心脏协会评分则为 16.3%。在 211 例有风险评分的患者中，有 179 例（84.8%）需要他汀类药物（高强度他汀类药物 175 例，97.8%），88 例（27.3%）需要阿司匹林作为一级预防；然而，56 例患者（31.3%）未接受任何他汀类药物，127 例（72.6%）未接受所需的高强度他汀类药物，38 例（有指征的患者的 43.2%）未服用阿司匹林。真实世界的数据表明，在一组心血管风险较高的患者中，相当一部分患者未接受降低风险所需的一级预防药物治疗，最终发生急性冠状动脉事件。
