Jamaluddin Jazlan, Mohamed-Kamel Mohd Azzahi, Din Nor Shazatul Salwana, Mohamad-Isa Mohamad Zikri
MD, MMed (Fam Med), Klinik Kesihatan Selayang Baru, Jalan Sungai Tua, Batu Caves, Selangor, Malaysia. Email:
MD, MMed (Fam Med), Klinik Kesihatan Lenggong, Jalan Besar, Kampung Batu Berdinding, Hulu Perak, Perak, Malaysia.
Malays Fam Physician. 2024 Jul 31;19:46. doi: 10.51866/oa.572. eCollection 2024.
Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events, particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics.
Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control.
Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of ≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities.
SPM prescription has increased over time, but the achievement of treatment targets, particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases.
开具二级预防药物（SPMs）以及有效控制心血管危险因素（RFs）对于降低心血管事件复发风险至关重要，尤其是在包括糖尿病（DM）患者在内的高危个体中。本研究旨在分析霹雳州健康诊所中糖尿病和心血管疾病患者的SPM处方趋势，并确定与RF控制相关的因素。
从国家糖尿病登记处提取2018年至2022年审核的缺血性心脏病（IHD）和脑血管疾病（CeVDs）患者的数据，不包括失访患者。进行描述性和趋势分析。采用多变量逻辑回归来确定与RF控制相关的因素。
大多数患者（76.7%）年龄≥60岁，为马来人（62.3%）。大多数患者IHD（60.8%）和CeVDs（54.7%）病程≥5年。在过去五年中，SPM处方显著增加。然而，血压（BP）和血脂控制保持不变。良好的血压控制与糖尿病病程≥10年相关，而控制不佳与马来族裔以及开具两种或三种抗高血压药物有关。良好的糖尿病控制与年龄≥60岁以及糖尿病诊断时年龄≥60岁相关，而控制不佳与马来族和印度族裔、糖尿病病程≥10年以及开具两种或三种及以上降糖药物有关。血脂控制不佳仅与马来族和印度族裔相关。
随着时间的推移，SPM处方有所增加，但治疗目标的实现情况，尤其是血脂控制方面，仍然较差且没有变化。他汀类药物的使用与血脂控制无关。必须提高替代降脂药物的可及性和可得性，以加强糖尿病和心血管疾病患者的整体RF控制，尤其是血脂控制。
