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根据个体化建议控制心血管风险因素:一项随机对照试验。

Control of cardiovascular risk factors with tailored recommendations: A randomized controlled trial.

机构信息

Cardiovascular Epidemiology and Genetics Research Group, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, School of Medicine, Autonomous University of Barcelona, Spain; Eastfield Health, Ashburton, New Zealand.

Cardiovascular Risk and Nutrition, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; School of Health Sciences, Blanquerna-Ramon Llull University, Barcelona, Spain.

出版信息

Prev Med. 2020 Dec;141:106302. doi: 10.1016/j.ypmed.2020.106302. Epub 2020 Nov 2.

Abstract

This study analyzed the efficacy of tailored recommendations to control cardiovascular risk factors at 1-year follow-up in a population-based randomized controlled trial in individuals aged 35-74 years with no history of cardiovascular disease at baseline. Total, low-density lipoprotein (LDL), and high-density lipoprotein cholesterol and systolic and diastolic blood pressure (BP) were measured at baseline and at 1-year follow-up. The primary outcome was the quantitative change in total cholesterol. To estimate the differences within and between groups, McNemar and Student t-tests were applied according to an intention-to-treat strategy. We enrolled 955 individuals [52.3% women; mean age, 50 years (standard deviation 10)]. Finally, 1 participant in each group presented a cardiovascular event and 768 were reexamined at 1-year follow-up. Intervention and control groups showed significant increases in total cholesterol [5.49 (standard deviation 1.02) to 5.56 (1.06) mmol/L and 5.34 (0.94) to 5.43 (0.93) mmol/L, respectively]. Men in the intervention group showed significant decreases in systolic and diastolic BP [117.2 (14.6) to 115.6 mmHg (14.1) and 77.9 (9.7) to 76.5 mmHg (9.7), respectively]; no changes were found in the rates of total cholesterol <5.2 mmol/L and LDL cholesterol <3.0 mmol/L. In the control group, both values were significantly decreased (43.5 to 36.4% and 26.4 to 20.8%, respectively) in men. In the stratified analysis, women showed no differences in any of the outcomes. In conclusion, an intervention with tailored recommendations increased mean total cholesterol values. The intervention effect was higher in men who maintained blood lipids at optimal levels and had decreased BP values.

摘要

本研究分析了在一项针对无心血管疾病病史的 35-74 岁人群的基于人群的随机对照试验中,针对心血管风险因素的个体化推荐对 1 年随访时的疗效。在基线和 1 年随访时测量总胆固醇、低密度脂蛋白(LDL)、高密度脂蛋白胆固醇和收缩压及舒张压。主要结局是总胆固醇的定量变化。为了估计组内和组间的差异,根据意向治疗策略应用 McNemar 和学生 t 检验。我们共纳入 955 名患者[52.3%为女性;平均年龄 50 岁(标准差 10 岁)]。最终,每组各有 1 名患者发生心血管事件,768 名患者在 1 年随访时接受了复查。干预组和对照组的总胆固醇均显著增加[5.49(标准差 1.02)mmol/L 增至 5.56(1.06)mmol/L 和 5.34(0.94)mmol/L 增至 5.43(0.93)mmol/L]。干预组男性的收缩压和舒张压显著降低[117.2(14.6)mmHg 降至 115.6mmHg(14.1)和 77.9(9.7)mmHg 降至 76.5mmHg(9.7)];总胆固醇<5.2mmol/L 和 LDL 胆固醇<3.0mmol/L 的比例无变化。在对照组中,男性的这两项指标均显著降低(分别为 43.5%降至 36.4%和 26.4%降至 20.8%)。分层分析显示,女性在任何结局上均无差异。结论:个体化推荐的干预措施增加了平均总胆固醇值。在维持血脂处于最佳水平且血压值降低的男性中,干预效果更高。

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