在 38 个低收入和中等收入国家实现心血管疾病二级预防指南推荐目标。

Achievement of Guideline-Recommended Targets for Secondary Prevention of Cardiovascular Disease in 38 Low-Income and Middle-Income Countries.

机构信息

Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.

出版信息

J Epidemiol Glob Health. 2024 Sep;14(3):1022-1031. doi: 10.1007/s44197-024-00251-3. Epub 2024 Jun 3.

DOI:10.1007/s44197-024-00251-3

PMID:38829488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11444037/

Abstract

BACKGROUND

This study aimed to estimate the prevalence of achieving the secondary prevention targets recommended in the World Health Organization (WHO) guidelines for cardiovascular disease (CVD) in 38 low-income and middle-income countries (LMICs).

METHODS

We pooled nationally representative cross-sectional surveys from 38 LMICs between 2013 and 2020. Treatment, metabolic and lifestyle targets were assessed for individuals with a self-reported history of CVD according to WHO's recommendations. Associations between the prevalence of guideline adherence and sociodemographic characteristics were assessed using multivariate Poisson regression models.

RESULTS

The pooled sample included 126 106 participants, of whom 9821 (6.8% [95% CI 6.4-7.2]) reported a history of CVD. Overall, the prevalence of achieving treatment targets in patients with CVD was 22.7% (95% CI, 21.0-24.5%) for antihypertensive drugs, 19.6% (17.9-21.4%) for aspirin, and 13.6% (12.0-15.44%) for statins. The prevalence of achieving metabolic targets was 54.9% (52.5-57.3%) for BMI, 39.9% (37.7-42.2%) for blood pressure, 46.1% (43.6-48.6%) for total cholesterol, and 84.9% (83.1-86.5%) for fasting blood glucose. The prevalence of achieving lifestyle targets was 83.2% (81.5-84.7%) for not smoking, 83.1% (81.2-84.9%) for not drinking, 65.5% (63.1-67.7%) for sufficient physical activity and 16.2% (14.5-18.0%) for healthy diet. Only 6.1% (5.1-7.4%) achieved three treatment targets, 16.0% (14.3-17.9%) achieved four metabolic targets, and 6.9% (5.8-8.0%) achieved four lifestyle targets. Upper-middle income countries were better than low-income countries at achieving the treatment, non-drinking and dietary targets. Being younger and female were associated with poorer achievement of metabolic targets.

CONCLUSION

In LMICs, achieving the targets recommended in the guideline for treatment, metabolism and healthy lifestyles for patients with CVD is notably low. This highlights an urgent need for effective, systematic secondary prevention strategies to improve CVD management.

摘要

背景

本研究旨在评估在 38 个低收入和中等收入国家（LMICs）中，根据世界卫生组织（WHO）心血管疾病（CVD）指南推荐，实现二级预防目标的患病率。

方法

我们汇总了 2013 年至 2020 年期间 38 个 LMICs 的全国代表性横断面调查。根据 WHO 的建议，对有自我报告 CVD 病史的个体进行治疗、代谢和生活方式目标评估。使用多变量泊松回归模型评估遵循指南的患病率与社会人口统计学特征之间的关联。

结果

汇总样本包括 126106 名参与者，其中 9821 名（6.8%[95%CI 6.4-7.2%]）报告有 CVD 病史。总体而言，CVD 患者的治疗目标达标率为降压药物 22.7%（95%CI，21.0-24.5%）、阿司匹林 19.6%（17.9-21.4%）和他汀类药物 13.6%（12.0-15.44%）。代谢目标达标率为 BMI 54.9%（52.5-57.3%）、血压 39.9%（37.7-42.2%）、总胆固醇 46.1%（43.6-48.6%）和空腹血糖 84.9%（83.1-86.5%）。生活方式目标达标率为不吸烟 83.2%（81.5-84.7%）、不饮酒 83.1%（81.2-84.9%）、有足够的体力活动 65.5%（63.1-67.7%）和健康饮食 16.2%（14.5-18.0%）。仅有 6.1%（5.1-7.4%）达到三个治疗目标，16.0%（14.3-17.9%）达到四个代谢目标，6.9%（5.8-8.0%）达到四个生活方式目标。中上收入国家在实现治疗、非饮酒和饮食目标方面优于低收入国家。年龄较小和女性与代谢目标达标情况较差相关。