2016—2019年湖南省心血管疾病患者二级预防用药调查

Investigation on the use of secondary prevention drugs in patients with cardiovascular diseases in Hunan province from 2016 to 2019

目的评估湖南省社区人群中既往心血管疾病(cardiovascular disease,CVD)患者的二级预防抗血小板药或他汀类药物的用药情况,并明确其与个体特征的相关性。方法利用2016—2019年湖南省CVD高危人群早期筛查与综合干预项目(简称“高危筛查项目”)采集的数据,选取湖南省12个县/区的137818例35~75岁的常住居民,通过问卷调查的方式,收集调查对象自报缺血性心脏病和/或缺血性脑卒中患病情况以及相关药物使用情况。使用多变量混合效应模型,以社区水平作为随机截距效应,评估个体特征与二级预防用药治疗的相关性。结果在137818例调查对象中,患有缺血性心脏病和/或缺血性脑卒中2779例(2.02%),自报使用抗血小板药物或他汀类药物360例(12.95%),仅使用抗血小板药物155例(5.58%),仅使用他汀类药物85例(3.06%),2种药物均使用120例(4.32%)。抗血小板药物使用率高于他汀类药物使用率,差异有统计学意义(χ^(2)=21.34,P<0.01)。抗血小板药物和他汀类药物的使用率中,男性、城市、非农民、高教育程度、高收入人群的药物使用率高于女性、农村、农民、低教育程度和低收入人群,差异有统计学意义(χ^(2)=16.82、5.30、60.14、7.42、3.08,P<0.05)。多因素分析结果显示,女性(OR=0.68,95%CI:0.49~0.95,P=0.02)和已婚人群(OR=0.62,95%CI:0.40~0.94,P=0.03)服用抗血小板药或他汀类药物的可能性更低,而高教育水平(初中:OR=1.60,95%CI:1.13~2.27,P=0.01;高中:OR=2.01,95%CI:1.25~3.22,P<0.01)和高血压患者(OR=1.53,95%CI:1.14~2.07,P=0.01)的药物使用率更高。结论湖南省CVD患者二级预防药物使用率较低,且不同人口学特征人群的差异较大。应针对女性、低学历、低收入等弱势群体量身定制有针对性的CVD二级预防干预措施,并加强基层社区医生对二级预防用药指南的认识和理解,以提升CVD患者二级预防药物治疗依从性,改善二级预防现状,降低疾病负担。

Objective To estimate the current use of secondary prevention drugs(antiplatelet drugs or statins)in patients with previous cardiovascular diseases(CVD)in a community-based population in Hunan province and to clarify their correlation with individual characteristics.Methods Using the data collected from the 2016-2019 Hunan Province in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project,137818 cases of permanent residents aged 35-75 years in 12 counties/districts in Hunan province were selected using a questionnaire.Self-reported prevalence of ischemic heart disease(IHD)and/or ischemic stroke(IS)and related medication use were collected from the participants.Multivariable mixed-effects models with community level as a random intercept effect were fitted to assess the associations of individual characteristics with the reported use of secondary prevention drugs therapy.Results Among the 137818 participants,2779(2.02%)had a history of IHD and/or IS,among whom the self-reported use rate of either antiplatelet drugs or statins was 360(12.95%),the proportion using only antiplatelet drugs was 155(5.58%),the proportion using only statins was 85(3.06%),and 120(4.32%)used both drugs.The use of antiplatelet drugs was higher than that of stains,with a statistically significant difference(χ^(2)=21.34,P<0.01).Among those who used antiplatelet drugs and stains,males,urban residents,non-farmers,those with higher education levels,and higher income groups had higher drug use rates than females,rural residents,farmers,those with lower education levels,and lower income groups,with statistically significant differences(χ^(2)=16.82,5.30,60.14,7.42,3.08,P<0.05).The results of the multivariable analysis showed that the likelihood of using antiplatelet or statin drugs was lower among females(OR=0.68,95%CI:0.49-0.95,P=0.02)and married individuals(OR=0.62,95%CI:0.40-0.94,P=0.03),while the drug use rate was higher among those with higher education levels(junior high school:OR=1.60,95%CI:1.13-2.27,P=0.01;high school:OR=2.01,95%CI:1.25-3.22,P<0.01)and people with hypertension(OR=1.53,95%CI:1.14-2.07,P=0.01).Conclusions The current use of secondary prevention drugs among CVD patients in Hunan Province is low and varies widely across populations with different demographic characteristics.Targeted secondary prevention interventions should be developed for vulnerable groups such as women with lower education levels and lower incomes.,Primary care physicians should also improve their understanding of secondary prevention medication guidelines to improve medication compliance and reduce the burden of CVD.